Provider Demographics
NPI:1427114453
Name:LANGEWISCH, MATTHEW HENRY (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:HENRY
Last Name:LANGEWISCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W BERGEN DR
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2310
Mailing Address - Country:US
Mailing Address - Phone:414-540-2393
Mailing Address - Fax:
Practice Address - Street 1:5019 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-1121
Practice Address - Country:US
Practice Address - Phone:414-445-6500
Practice Address - Fax:414-445-6618
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026563122300000X
WI5824-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist