Provider Demographics
NPI:1861508699
Name:LANGAN, KEVIN P (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:P
Last Name:LANGAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SHIRE DR
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-5608
Mailing Address - Country:US
Mailing Address - Phone:203-235-3539
Mailing Address - Fax:
Practice Address - Street 1:35 PLEASANT ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-5786
Practice Address - Country:US
Practice Address - Phone:203-235-3539
Practice Address - Fax:203-238-7962
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice