Provider Demographics
NPI:1851683510
Name:LANGE, GENEVIEVE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
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:#6 MCBRIDE AND SON CORPORATE CENTER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005
Mailing Address - Country:US
Mailing Address - Phone:636-532-5535
Mailing Address - Fax:636-537-8499
Practice Address - Street 1:#6 MCBRIDE AND SON CORPORATE CENTER DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005
Practice Address - Country:US
Practice Address - Phone:636-532-5535
Practice Address - Fax:636-537-8499
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100406071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics