Provider Demographics
NPI:1003575507
Name:LANGE, TONYA
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:
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 6764
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424
Mailing Address - Country:US
Mailing Address - Phone:320-761-6892
Mailing Address - Fax:
Practice Address - Street 1:965 N 10 MILE DR
Practice Address - Street 2:UNIT A5
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-2207
Practice Address - Country:US
Practice Address - Phone:970-668-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-12
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002025877124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist