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General NPI Number Information
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NPI Number | 1932796885
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Entity Type | Organization
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Legal Business Name | WSL DENTAL MANAGEMENT LLC
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Dates
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Enumeration Date | 12/27/2020
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Last Update Date | 12/27/2020
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Provider Practice Location Address
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Address Line | 114 4TH ST
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City | TIPTON
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State | IN
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Zip | 46072-1851
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Country | US
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Telephone | 765-675-2432
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Fax |
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Provider Business Mailing Address
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Address Line | 3843 IDLEWIND DR
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City | WESTFIELD
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State | IN
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Zip | 46074-6315
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Country | US
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Telephone | 715-482-2323
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WALTER SAMUEL LANGKAU
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Credential | DDS
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Telephone | 715-482-2323
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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 |
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License Number State |
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