Organization
TIMOTHY C. LANG, DDS, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY CORRIGAN LANG DDS, MD (CEO)
(321) 777-2166
Entity
Organization
Contact information
Practice address
2030 S PATRICK DR, SUITE 1, INDIAN HARBOUR BEACH, FL 32937-4400
(321) 777-2166
(321) 777-2191
Mailing address
2030 S PATRICK DR, SUITE 1, INDIAN HARBOUR BEACH, FL 32937-4400
(321) 777-2166
(321) 777-2191
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
ME0068501
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
253999300
—
FL
01
—
27225
BLUE CROSS BLUE SHIELD
FL
01
—
791334
UNITED CONCORDIA ID
—
01
—
995474
COMPBENEFITS FACILITY NUM
FL
Enumeration date
05/15/2007
Last updated
04/13/2016
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