Provider Demographics
NPI:1457490112
Name:LANGSDORF PS
Entity Type:Organization
Organization Name:LANGSDORF PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-892-1776
Mailing Address - Street 1:11600 SE MILL PLAIN BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5083
Mailing Address - Country:US
Mailing Address - Phone:360-892-1776
Mailing Address - Fax:360-892-8825
Practice Address - Street 1:11600 SE MILL PLAIN BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5083
Practice Address - Country:US
Practice Address - Phone:360-892-1776
Practice Address - Fax:360-892-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty