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General NPI Number Information
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NPI Number | 1699251801
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Entity Type | Individual
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Provider Name | KATHRYN LANGEVIN DMD
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Gender | Female
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 108 S MAIN STREET
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City | BIRCHWOOD
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State | WI
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Zip | 54817
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Country | US
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Telephone | 715-354-3369
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Fax |
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Provider Business Mailing Address
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Address Line | 15954 RIVERS EDGE DR STE 304
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City | HAYWARD
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State | WI
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Zip | 54843-7894
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Country | US
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Telephone | 715-634-2541
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1001890
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License Number State | WI
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