Provider Demographics
NPI:1396398673
Name:LANGDON, JEFFREY POWERS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:POWERS
Last Name:LANGDON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 AMMONS DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-5371
Mailing Address - Country:US
Mailing Address - Phone:650-776-0840
Mailing Address - Fax:
Practice Address - Street 1:303 E A ST
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:OR
Practice Address - Zip Code:97048-3132
Practice Address - Country:US
Practice Address - Phone:971-251-6154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD112641223G0001X, 122300000X
SC9454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist