Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 21335 | TX |
NPI | 1265464812 |
---|---|
Provider Name | Dr. Judd Gardner Langley |
First Address | Palestine, TX 75801-4780 |
Second Address | Palestine, TX 75801-4780 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 04/06/2009 |