Provider Demographics
NPI:1306832431
Name:LANG, TIMOTHY CORRIGAN (DDS, MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CORRIGAN
Last Name:LANG
Suffix:
Gender:M
Credentials:DDS, MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 S PATRICK DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4400
Mailing Address - Country:US
Mailing Address - Phone:321-777-2166
Mailing Address - Fax:321-777-2191
Practice Address - Street 1:2030 S PATRICK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4400
Practice Address - Country:US
Practice Address - Phone:321-777-2166
Practice Address - Fax:321-777-2191
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00685011223S0112X
FLDN140851223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
791334OtherUNITED CONCORDIA PROVIDER
FL253999300Medicaid
FL27225OtherBLUE CROSS/BLUE SHIELD
791334OtherUNITED CONCORDIA PROVIDER
FL253999300Medicaid
FL27225YMedicare PIN