Provider Demographics
NPI:1104002435
Name:LANDIS, HAROLD EUGENE (DDS)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:EUGENE
Last Name:LANDIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 GEORGIA AVE
Mailing Address - Street 2:SUITE 228A
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5276
Mailing Address - Country:US
Mailing Address - Phone:301-681-7061
Mailing Address - Fax:
Practice Address - Street 1:9801 GEORGIA AVE
Practice Address - Street 2:SUITE 228A
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5276
Practice Address - Country:US
Practice Address - Phone:301-681-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8461122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist