1154592905 NPI number — TATE C LANGDON DDS PA

Table of content: (NPI 1154592905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154592905 NPI number — TATE C LANGDON DDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TATE C LANGDON DDS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154592905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10210 HICKORYWOOD HILL AVE
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
HUNTERSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28078-3332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-875-0123
Provider Business Mailing Address Fax Number:
704-875-0646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10210 HICKORYWOOD HILL AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
HUNTERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28078-3332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-875-0123
Provider Business Practice Location Address Fax Number:
704-875-0646
Provider Enumeration Date:
03/20/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LANGDON
Authorized Official First Name:
TATE
Authorized Official Middle Name:
CHRISTOPHER
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
704-875-0123

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  7624 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)