Provider Demographics
NPI:1295229367
Name:LANDHOLM, JAMES CLINTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLINTON
Last Name:LANDHOLM
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 1:7140 N GRAND LAKE DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-9095
Mailing Address - Country:US
Mailing Address - Phone:402-276-7742
Mailing Address - Fax:
Practice Address - Street 1:137 N 7TH ST
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2017
Practice Address - Country:US
Practice Address - Phone:402-643-3909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE74621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice