MEDICARE: MRS. HIEN LONG TO-SCHWALBACH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D11775	MN
2	1223G0001X	General Practice Dentistry	D8838	OR
3	1223G0001X	General Practice Dentistry	6343-015	WI

General Provider Information

NPI Number	:	1891780433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HIEN LONG TO-SCHWALBACH DDS

Provider Business Mailing Address
First Line	:	1000 BADGER DR
Second Line	:
City	:	LAKE MILLS
State	:	WI
Zip	:	53551-1774
Country	:	US
Telephone Number	:	262-751-2081
Fax Number	:

Provider Business Practice Location Address
First Line	:	6420 COTTAGE GROVE RD
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53718-6592
Country	:	US
Telephone Number	:	608-222-8080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	01/28/2014

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