Provider Demographics
NPI:1841379542
Name:LANG, RAYMOND (DDS)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:LANG
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:PO BOX 1730
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762-0812
Mailing Address - Country:US
Mailing Address - Phone:907-443-2055
Mailing Address - Fax:907-443-3696
Practice Address - Street 1:504 BERING ST
Practice Address - Street 2:
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762-0812
Practice Address - Country:US
Practice Address - Phone:907-443-2055
Practice Address - Fax:907-443-3696
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist