Provider Demographics
NPI:1124046750
Name:LANDIS, LAWRENCE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:M
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 1:990 S CONGRESS AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4680
Mailing Address - Country:US
Mailing Address - Phone:561-278-0062
Mailing Address - Fax:
Practice Address - Street 1:990 S CONGRESS AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4680
Practice Address - Country:US
Practice Address - Phone:561-278-0062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN52261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice