Provider Demographics
NPI:1164535845
Name:MARK J LANDAU DDS LTD
Entity Type:Organization
Organization Name:MARK J LANDAU DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANDAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-675-2100
Mailing Address - Street 1:4709 GOLF ROAD
Mailing Address - Street 2:SUITE 809
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:847-675-2100
Mailing Address - Fax:847-675-2102
Practice Address - Street 1:4709 GOLF ROAD
Practice Address - Street 2:SUITE 809
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-675-2100
Practice Address - Fax:847-675-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
341200Medicare UPIN