Provider Demographics
NPI:1205103330
Name:LANGGUTH, JULIE MIKHAIL (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:MIKHAIL
Last Name:LANGGUTH
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 FORBES ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1502
Mailing Address - Country:US
Mailing Address - Phone:410-267-7300
Mailing Address - Fax:
Practice Address - Street 1:114 FORBES ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1502
Practice Address - Country:US
Practice Address - Phone:410-267-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD144211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics