Provider Demographics
NPI:1033793773
Name:LANDSMAN, MELISSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:LANDSMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17650 PLUM CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-5607
Mailing Address - Country:US
Mailing Address - Phone:440-829-4011
Mailing Address - Fax:
Practice Address - Street 1:1234 S HOVER ST STE 100
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7962
Practice Address - Country:US
Practice Address - Phone:720-907-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODEN.00205189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program