Provider Demographics
NPI:1194038539
Name:LANG, JAMIE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MARIE
Last Name:LANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:LANG
Other - Last Name:RITCHIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1425 WAKARUSA DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3832
Mailing Address - Country:US
Mailing Address - Phone:785-841-3311
Mailing Address - Fax:785-843-0421
Practice Address - Street 1:1425 WAKARUSA DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3832
Practice Address - Country:US
Practice Address - Phone:785-841-3311
Practice Address - Fax:785-843-0421
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61270122300000X
TNDS00000091921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist