Provider Demographics
NPI:1487327342
Name:LANGFORD, JUSTIN ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ROBERT
Last Name:LANGFORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 KAMELA DR S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-1942
Mailing Address - Country:US
Mailing Address - Phone:503-866-1053
Mailing Address - Fax:
Practice Address - Street 1:2737 LANCASTER DR NE STE 150
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-4134
Practice Address - Country:US
Practice Address - Phone:503-364-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD114841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice