Provider Demographics
NPI:1154652485
Name:LANDRY, JOSEPH GERALD II (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GERALD
Last Name:LANDRY
Suffix:II
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 1:761 DENSHIRE DR NW
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-8663
Mailing Address - Country:US
Mailing Address - Phone:330-224-3007
Mailing Address - Fax:
Practice Address - Street 1:179 CENTER ST
Practice Address - Street 2:
Practice Address - City:SEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44273-9580
Practice Address - Country:US
Practice Address - Phone:330-769-4470
Practice Address - Fax:330-769-4479
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist