Organization
NORTH SHORE DENTAL L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLEN D LANGEBERG D.D.S. (PRESIDENT/OWNER)
(262) 242-1180
Entity
Organization
Contact information
Practice address
1345 W TOWNE SQUARE RD, MEQUON, WI 53092-5047
(262) 242-1180
Mailing address
1345 W TOWNE SQUARE RD, MEQUON, WI 53092-5047
(262) 242-1180
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2294
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38355900
—
WI
01
—
816118
UNITED CONCORDIA / TRI CARE INSURANCE
WI
Enumeration date
11/20/2008
Last updated
01/18/2013
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