Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DS039522 | PA |
Y | 1223P0300X | Periodontist | DS039522 | PA |
NPI | 1003225558 |
---|---|
Provider Name | Dr. Thomas Anthony Langan JR. |
First Address | South Abington Township, PA 18411 |
Second Address | Philadelphia, PA 19128-2245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2014 |
Last Update Date | 20/08/2016 |