Provider Demographics
NPI:1689146839
Name:ANDREW LANGSTON DMD PLLC
Entity Type:Organization
Organization Name:ANDREW LANGSTON DMD PLLC
Other - Org Name:THE FACIAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-242-2100
Mailing Address - Street 1:1371 BEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1975
Mailing Address - Country:US
Mailing Address - Phone:321-242-2100
Mailing Address - Fax:321-242-6626
Practice Address - Street 1:1371 BEDFORD DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1975
Practice Address - Country:US
Practice Address - Phone:321-242-2100
Practice Address - Fax:321-242-6626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty