Provider Demographics
NPI:1831398502
Name:LANG, JASON WILLIAM (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:WILLIAM
Last Name:LANG
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:11300 E 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2500
Mailing Address - Country:US
Mailing Address - Phone:586-573-6308
Mailing Address - Fax:586-573-6308
Practice Address - Street 1:1982 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1520
Practice Address - Country:US
Practice Address - Phone:810-985-7300
Practice Address - Fax:810-985-7803
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010183761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics