Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH4077 | TN |
NPI | 1063595676 |
---|---|
Provider Name | Mrs. Judy Renee Langston |
First Address | Mt Juliet, TN 37122-2044 |
Second Address | Hermitage, TN 37076-1354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |