Provider Demographics
NPI:1447260211
Name:THOMAS H LANGE DDS FAGD PC
Entity type:Organization
Organization Name:THOMAS H LANGE DDS FAGD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:HOFFMAN
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-452-5520
Mailing Address - Street 1:8950 VILLA LA JOLLA DRIVE
Mailing Address - Street 2:STE A105
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-452-5520
Mailing Address - Fax:858-452-5525
Practice Address - Street 1:8950 VILLA LA JOLLA DRIVE
Practice Address - Street 2:STE A105
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-452-5520
Practice Address - Fax:858-452-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24132122300000X
CA48749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty