Provider Demographics
NPI:1174500359
Name:LANGLEY, DAVID C (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:LANGLEY
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 1:645 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ZUMBROTA
Mailing Address - State:MN
Mailing Address - Zip Code:55992-1037
Mailing Address - Country:US
Mailing Address - Phone:507-732-7682
Mailing Address - Fax:
Practice Address - Street 1:1ST STREET & MINNESOTA HIGHWAY 60
Practice Address - Street 2:LOWER LEVEL OF FIRST STATE BANK OF RED WING
Practice Address - City:MAZEPPA
Practice Address - State:MN
Practice Address - Zip Code:55956
Practice Address - Country:US
Practice Address - Phone:507-843-5734
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN93591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice