Individual
JENNA LANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
336 S MAIN ST, SHAWANO, WI 54166-2754
(715) 524-3565
Mailing address
W10186 MEADOW LN, GRESHAM, WI 54128-8914
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6943-15
WI
Other
Enumeration date
07/06/2012
Last updated
07/06/2012
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