Provider Demographics
NPI:1508032400
Name:JUERGEN LANGENBACH, DMD, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:JUERGEN LANGENBACH, DMD, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUERGEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-451-3110
Mailing Address - Street 1:15725 POMERADO RD STE 104
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2057
Mailing Address - Country:US
Mailing Address - Phone:858-451-3110
Mailing Address - Fax:858-451-2916
Practice Address - Street 1:15725 POMERADO RD STE 104
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2057
Practice Address - Country:US
Practice Address - Phone:858-451-3110
Practice Address - Fax:858-451-2916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50631261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental