Organization
LANGE FAMILY DENTISTRY, LLC
Active
Other names
Edwards Lake Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW JASON LANGE DMD (OWNER)
(205) 655-8090
Entity
Organization
Contact information
Practice address
1930 EDWARDS LAKE RD, SUITE 134, BIRMINGHAM, AL 35235-3718
(205) 655-8090
Mailing address
1930 EDWARDS LAKE RD, SUITE 134, BIRMINGHAM, AL 35235-3718
(205) 655-8090
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5760
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125232
—
AL
Enumeration date
08/02/2012
Last updated
08/02/2012
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