NPIMap

Organization Active NPI

North Shore Dental Group S.C.

  • General Practice Dentistry
  • Mequon, WI
National Provider Identifier
1093868523
Registry record updated Nov 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2294 Issued in WI
Legal business name
NORTH SHORE DENTAL GROUP S.C.
Practice address
2601 W Mequon Rd
Mequon, WI 53092-3151
Phone
(262) 242-1180
Fax
(262) 242-0930
NPI assigned
Jan 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Allen D Langeberg, D.D.S.
Title
Vice President
Phone
(262) 242-1180

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 2294 WI Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 0776G WI

Addresses

Primary practice location

2601 W Mequon Rd
Mequon, WI 53092-3151

Mailing address

11345 N Port Washington Rd
Mequon, WI 53092-3411
Phone (262) 242-1180

Other identifiers 2

IdentifierTypeStateIssuer
816118OtherWIUNITED CONCORDIA INSURANC
38355900MedicaidWI

National Provider Directory

National Provider Directory

Locations

2601 W Mequon Rd
Mequon, WI 53092
Phone (262) 242-1180

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226448000000",
    "number": "1093868523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11345 N PORT WASHINGTON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923411",
            "telephone_number": "262-242-1180",
            "fax_number": "262-242-0930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 W MEQUON RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923151",
            "telephone_number": "262-242-1180",
            "fax_number": "262-242-0930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE DENTAL GROUP S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2008-11-12",
        "status": "A",
        "authorized_official_last_name": "LANGEBERG",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "262-242-1180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "2294",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "0776G",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA INSURANC",
            "identifier": "816118",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38355900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.