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General NPI Number Information
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NPI Number | 1508032400
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Entity Type | Organization
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Legal Business Name | JUERGEN LANGENBACH, DMD, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 15725 POMERADO RD STE 104
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City | POWAY
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State | CA
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Zip | 92064-2057
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Country | US
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Telephone | 858-451-3110
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Fax | 858-451-2916
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Provider Business Mailing Address
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Address Line | 15725 POMERADO RD STE 104
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City | POWAY
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State | CA
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Zip | 92064-2057
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Country | US
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Telephone | 858-451-3110
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Fax | 858-451-2916
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUERGEN LANGENBACH
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Credential | DMD
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Telephone | 858-451-3110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 50631
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License Number State | CA
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