Provider Demographics
NPI:1306851795
Name:LANGELL, DOUGLAS GRAHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GRAHAM
Last Name:LANGELL
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 1:1370 FOOTHILL BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:LACANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011
Mailing Address - Country:US
Mailing Address - Phone:818-952-6193
Mailing Address - Fax:818-952-6189
Practice Address - Street 1:1370 FOOTHILL BLVD
Practice Address - Street 2:STE 101
Practice Address - City:LACANADA
Practice Address - State:CA
Practice Address - Zip Code:91011
Practice Address - Country:US
Practice Address - Phone:818-952-6193
Practice Address - Fax:818-952-6189
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA035044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA152001OtherDELTA PHI
CA0459OtherSMILE SAVER
CA5101OtherPACIFIC UNION