Provider Demographics
NPI:1013206994
Name:LANDERS AND ASSOCIATES, DMD, P.A.
Entity Type:Organization
Organization Name:LANDERS AND ASSOCIATES, DMD, P.A.
Other - Org Name:OASIS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-548-2700
Mailing Address - Street 1:8440 PIT STOP CT NW
Mailing Address - Street 2:SUITE A&B
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8245
Mailing Address - Country:US
Mailing Address - Phone:704-548-2700
Mailing Address - Fax:704-548-2767
Practice Address - Street 1:8440 PIT STOP CT NW
Practice Address - Street 2:SUITE A&B
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8245
Practice Address - Country:US
Practice Address - Phone:704-548-2700
Practice Address - Fax:704-548-2767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC88921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1861722415OtherNPI
NC5908545Medicaid