Provider Demographics
NPI:1154356988
Name:LANGSTON, JOHN REYNOLDS (DDSMS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:REYNOLDS
Last Name:LANGSTON
Suffix:
Gender:M
Credentials:DDSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 WATERHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BOURNE
Mailing Address - State:MA
Mailing Address - Zip Code:02532-8340
Mailing Address - Country:US
Mailing Address - Phone:508-759-4495
Mailing Address - Fax:508-759-0840
Practice Address - Street 1:114 WATERHOUSE RD
Practice Address - Street 2:
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532-8340
Practice Address - Country:US
Practice Address - Phone:508-759-4495
Practice Address - Fax:508-759-0840
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA176241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA758041OtherTUFTS
MAX06280OtherBCBS
MA16160OtherHARVARD PILGRIM
MAM20758OtherMEDICARE GRP
MAX06280OtherBCBS
MAX06280Medicare ID - Type UnspecifiedMEDICARE