=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962420596
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUERGEN LANGENBACH D.M.D., F.A.G.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 06/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15717 BERNARDO HEIGHTS PKWY
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92128-3155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-451-3110
-----------------------------------------------------
Fax | 858-451-2916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15717 BERNARDO HEIGHTS PKWY
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92128-3155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-451-3110
-----------------------------------------------------
Fax | 858-451-2916
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 50631
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------