Provider Demographics
NPI:1962884841
Name:MAIN STREET DENTAL, PC
Entity type:Organization
Organization Name:MAIN STREET DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-627-5460
Mailing Address - Street 1:6240 S MAIN ST STE 295
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5100
Mailing Address - Country:US
Mailing Address - Phone:303-627-5460
Mailing Address - Fax:
Practice Address - Street 1:6240 S MAIN ST STE 295
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5100
Practice Address - Country:US
Practice Address - Phone:303-627-5460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104888261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental