Provider Demographics
NPI:1407841778
Name:LANGSTEN, ROBERT E (DDS, ABGD,FAGD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:LANGSTEN
Suffix:
Gender:M
Credentials:DDS, ABGD,FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 BOATNER RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:EGLIN AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32542-1391
Mailing Address - Country:US
Mailing Address - Phone:850-883-8050
Mailing Address - Fax:850-883-8328
Practice Address - Street 1:96TH MEDICAL GROUP/SGD
Practice Address - Street 2:307 BOATNER ROAD, SUITE 114
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542
Practice Address - Country:US
Practice Address - Phone:850-883-8050
Practice Address - Fax:850-883-8328
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13677122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist