Provider Demographics
NPI:1760910947
Name:LANGDON, KURTIS WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:KURTIS
Middle Name:WILLIAM
Last Name:LANGDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8960 FITNESS LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8208
Mailing Address - Country:US
Mailing Address - Phone:317-845-9130
Mailing Address - Fax:
Practice Address - Street 1:8960 FITNESS LN
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-8208
Practice Address - Country:US
Practice Address - Phone:317-845-9130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012688A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1386650497OtherGENERAL DENTIST