Provider Demographics
NPI:1225129224
Name:LANDY, MICHAEL G (DDS, FAGD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:LANDY
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 131
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-5750
Mailing Address - Country:US
Mailing Address - Phone:202-872-1525
Mailing Address - Fax:202-237-2051
Practice Address - Street 1:4600 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 131
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-5750
Practice Address - Country:US
Practice Address - Phone:202-872-1525
Practice Address - Fax:202-237-2051
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3751122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist