Grand Line Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

GRAND LINE DENTISTRY

Practice address

39 W Church St
Evansville, WI 53536-1329

Phone

(608) 882-4860

Fax

(608) 882-4862

NPI assigned

Sep 22, 2026

Last updated

Sep 22, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Moah Kong Xiong, DDS

Title

Owner Dentist

Phone

(715) 297-6506

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1790035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790035200000",
    "number": "1144132101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "842 TWIN PINES DR",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537048560",
            "telephone_number": "715-297-6506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 W CHURCH ST",
            "city": "EVANSVILLE",
            "state": "WI",
            "postal_code": "535361329",
            "telephone_number": "608-882-4860",
            "fax_number": "608-882-4862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND LINE DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-22",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A",
        "authorized_official_last_name": "XIONG",
        "authorized_official_first_name": "MOAH",
        "authorized_official_middle_name": "KONG",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "715-297-6506",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin George, PTA
• John C Gernetzke, D.D.S.
• GL Healthcare
• GL Rehabilitation Services LTD
• Emily Anna Gorces, BSN, RN
• Elizabeth Nicole Halson, APNP
• Cali Hensel, DDS
• Chad Anton Hermanson
• Allison Herrick, PHARMD.
• Jacob Schoenenberger, OD

• Dental Clinic/Center in Evansville, WI
• Providers in Evansville, WI by specialty
• Dental Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.