Provider Demographics
NPI:1285797498
Name:LANGFORD, LISA ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 MIDDLEBELT ROAD
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141
Mailing Address - Country:US
Mailing Address - Phone:734-721-3800
Mailing Address - Fax:734-721-4746
Practice Address - Street 1:1250 MIDDLEBELT ROAD
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141
Practice Address - Country:US
Practice Address - Phone:734-721-3800
Practice Address - Fax:734-721-4746
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist