Healthcare Provider Details

I. General information

NPI: 1508032400
Provider Name (Legal Business Name): JUERGEN LANGENBACH, DMD, A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15717 BERNARDO HEIGHTS PKWY
SAN DIEGO CA
92128-3155
US

IV. Provider business mailing address

15717 BERNARDO HEIGHTS PKWY
SAN DIEGO CA
92128-3155
US

V. Phone/Fax

Practice location:
  • Phone: 858-451-4413
  • Fax: 858-451-2916
Mailing address:
  • Phone: 858-451-4413
  • Fax: 858-451-2916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number50631
License Number StateCA

VIII. Authorized Official

Name: DR. JUERGEN LANGENBACH
Title or Position: OWNER
Credential: DMD
Phone: 858-451-3110