Provider Demographics
NPI:1003955592
Name:LANDMARK DENTAL GROUP
Entity Type:Organization
Organization Name:LANDMARK DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-356-5444
Mailing Address - Street 1:6600 ABERCORN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5800
Mailing Address - Country:US
Mailing Address - Phone:912-356-5444
Mailing Address - Fax:912-356-1837
Practice Address - Street 1:6600 ABERCORN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5800
Practice Address - Country:US
Practice Address - Phone:912-356-5444
Practice Address - Fax:912-356-1837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty