=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427156330
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN E DARLING D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 W SILVER SPRING DR STE 285
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53217-5059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-964-7109
-----------------------------------------------------
Fax | 414-964-9510
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10440 N BEECHWOOD DR
-----------------------------------------------------
City | MEQUON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53092-5977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-241-8115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 3770-015
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------