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MR. JEROME ALLEN LANG DDS
General Practice >> Dentist >> Dental ProvidersRegistrant NPI Number: 1497829485
Individual Registrant:MR. JEROME ALLEN LANG DDS
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
105 KELLY WAY HORTONVILLE, WI 54944 US
Tel: 920-779-4982 Fax: 920-779-0930
Tel: 920-779-4982 Fax: 920-779-0930
Contact information for business:
105 KELLY WAY HORTONVILLE, WI 54944 US
Tel: 920-779-4982 Fax: 920-779-0930
Tel: 920-779-4982 Fax: 920-779-0930
Registration Information:
NPI: 1497829485
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1223G0001X | Dental Providers Dentist General Practice | WI | 5001375 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
