Organization
NORTH SHORE DENTAL GROUP S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALLEN D LANGEBERG D.D.S. (VICE PRESIDENT)
(262) 242-1180
Entity
Organization
Contact information
Practice address
2601 W MEQUON RD, MEQUON, WI 53092-3151
(262) 242-1180
(262) 242-0930
Mailing address
11345 N PORT WASHINGTON RD, MEQUON, WI 53092-3411
(262) 242-1180
(262) 242-0930
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
0776G
WI
1223G0001X
General Practice Dentistry
Primary
2294
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38355900
—
WI
01
—
816118
UNITED CONCORDIA INSURANC
WI
Enumeration date
01/19/2007
Last updated
11/12/2008
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