Provider Demographics
NPI:1285853093
Name:LAND, THOMAS DONALD (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DONALD
Last Name:LAND
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 1:30001 CROWN VALLEY PKWY
Mailing Address - Street 2:STE 6
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:949-495-4245
Mailing Address - Fax:949-495-6614
Practice Address - Street 1:30001 CROWN VALLEY PKWY
Practice Address - Street 2:STE 6
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677
Practice Address - Country:US
Practice Address - Phone:949-495-4245
Practice Address - Fax:949-495-6614
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20557122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist