Provider Demographics
NPI:1730332123
Name:JOHN E. DARLING, D.D.S., LLC
Entity type:Organization
Organization Name:JOHN E. DARLING, D.D.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DARLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-964-7109
Mailing Address - Street 1:200 W SILVER SPRING DR
Mailing Address - Street 2:STE 285
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217
Mailing Address - Country:US
Mailing Address - Phone:414-964-7109
Mailing Address - Fax:414-964-9510
Practice Address - Street 1:200 W SILVER SPRING DR
Practice Address - Street 2:STE 285
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217
Practice Address - Country:US
Practice Address - Phone:414-964-7109
Practice Address - Fax:414-964-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3770WI1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T79178Medicare PIN