Provider Demographics
NPI:1598011231
Name:WILLENBERG LANGHOLZ, DANAE JOY (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:DANAE
Middle Name:JOY
Last Name:WILLENBERG LANGHOLZ
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12723 N BELLWOOD DR STE 20
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-7275
Mailing Address - Country:US
Mailing Address - Phone:616-377-7333
Mailing Address - Fax:
Practice Address - Street 1:12723 N BELLWOOD DR STE 20
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7275
Practice Address - Country:US
Practice Address - Phone:616-377-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023771122300000X
MI29010227981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist