Provider Demographics
NPI:1801907043
Name:LANG, LISA A (DDS MS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:LANG
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2124 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3804
Mailing Address - Country:US
Mailing Address - Phone:216-368-6736
Mailing Address - Fax:216-368-0617
Practice Address - Street 1:2124 CORNELL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-3804
Practice Address - Country:US
Practice Address - Phone:216-368-6736
Practice Address - Fax:216-368-0617
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF219741223P0700X
OH30-0233571223P0700X
MI29010160551223P0700X
CO81381223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics