Provider Demographics
NPI:1114232022
Name:LANG, REBECCA (DMD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 SKY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1053
Mailing Address - Country:US
Mailing Address - Phone:601-613-0961
Mailing Address - Fax:
Practice Address - Street 1:815 COLLEGE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-6261
Practice Address - Country:US
Practice Address - Phone:760-414-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60494122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist