Provider Demographics
NPI:1114045119
Name:LANGENFELD, BRIAN W (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:LANGENFELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 S MAIN ST
Mailing Address - Street 2:SUITE 295
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5321
Mailing Address - Country:US
Mailing Address - Phone:303-627-5460
Mailing Address - Fax:303-627-5438
Practice Address - Street 1:6240 S MAIN ST
Practice Address - Street 2:SUITE 295
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5321
Practice Address - Country:US
Practice Address - Phone:303-627-5460
Practice Address - Fax:303-627-5438
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1048881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice