Organization Name: | LITTLE SPROUTS DENTAL, LLC |
NPI Number: | 1417298696 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MATTHEW H. LANGEWISCH (MANAGING MEMBER) |
Mailing Address: | W62n563 Washington Ave Lower Level Cedarburg |
State: | WI US |
Postal Code: | 530121986 |
Phone Number: | 2622970079 |
Fax Number: | |
NPI Enumeration Date: | 03/13/2013 |
NPI Last Update Date: | 03/13/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 5824-15 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |