Provider Demographics
NPI:1124289087
Name:LANGOWSKI, BRIAN R (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:LANGOWSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4344 N KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2121
Mailing Address - Country:US
Mailing Address - Phone:773-736-3442
Mailing Address - Fax:773-736-3494
Practice Address - Street 1:4344 N KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2121
Practice Address - Country:US
Practice Address - Phone:773-736-3442
Practice Address - Fax:773-736-3494
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190172231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice