Provider Demographics
NPI:1962420596
Name:LANGENBACH, JUERGEN (DMD, FAGD)
Entity type:Individual
Prefix:DR
First Name:JUERGEN
Middle Name:
Last Name:LANGENBACH
Suffix:
Gender:M
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice