Provider Demographics
NPI:1811277478
Name:LESIA LANGSTON-MCKENNA, DMD
Entity type:Organization
Organization Name:LESIA LANGSTON-MCKENNA, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANGSTON-MCKENNA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:937-393-1472
Mailing Address - Street 1:819 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2128
Mailing Address - Country:US
Mailing Address - Phone:937-383-1913
Mailing Address - Fax:937-655-8809
Practice Address - Street 1:819 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2128
Practice Address - Country:US
Practice Address - Phone:937-383-1913
Practice Address - Fax:937-655-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31-0177701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty