Provider Demographics
NPI:1710098116
Name:BRAVMAN LANGSTON AND ASSOCIATES ORAL & MAXILLOFACIAL SURGERY LLC
Entity Type:Organization
Organization Name:BRAVMAN LANGSTON AND ASSOCIATES ORAL & MAXILLOFACIAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:LANGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:508-759-4495
Mailing Address - Street 1:114 WATERHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BOURNE
Mailing Address - State:MA
Mailing Address - Zip Code:02532-8340
Mailing Address - Country:US
Mailing Address - Phone:508-759-4495
Mailing Address - Fax:508-759-0840
Practice Address - Street 1:236 MAIN ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540
Practice Address - Country:US
Practice Address - Phone:508-495-3700
Practice Address - Fax:508-495-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M20758Medicare ID - Type Unspecified