Provider Demographics
NPI:1063595676
Name:LANGSTON, JUDY RENEE (RDH)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:RENEE
Last Name:LANGSTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 BEACON HILL LN
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-2044
Mailing Address - Country:US
Mailing Address - Phone:615-758-4589
Mailing Address - Fax:
Practice Address - Street 1:4761 ANDREW JACKSON PKWY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1354
Practice Address - Country:US
Practice Address - Phone:615-885-3525
Practice Address - Fax:615-885-9767
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDH4077124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist