Provider Demographics
NPI:1265464812
Name:LANGLEY, JUDD GARDNER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUDD
Middle Name:GARDNER
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 1:100 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-4780
Mailing Address - Country:US
Mailing Address - Phone:903-729-7286
Mailing Address - Fax:903-729-6395
Practice Address - Street 1:100 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4780
Practice Address - Country:US
Practice Address - Phone:903-729-7286
Practice Address - Fax:903-729-6395
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213351223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics