Provider Demographics
NPI:1144390162
Name:LANDERS, THOMAS E (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:LANDERS
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 1:430 DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-2383
Mailing Address - Country:US
Mailing Address - Phone:815-786-9811
Mailing Address - Fax:815-786-6221
Practice Address - Street 1:430 DAYTON ST
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-2383
Practice Address - Country:US
Practice Address - Phone:815-786-9811
Practice Address - Fax:815-786-6221
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice