Provider Demographics
NPI:1164737391
Name:LANGE, ANDREW JASON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JASON
Last Name:LANGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 EDWARDS LAKE RD
Mailing Address - Street 2:SUITE 134
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3718
Mailing Address - Country:US
Mailing Address - Phone:205-655-8090
Mailing Address - Fax:
Practice Address - Street 1:1930 EDWARDS LAKE RD
Practice Address - Street 2:SUITE 134
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3718
Practice Address - Country:US
Practice Address - Phone:205-655-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice