Provider Demographics
NPI:1326394446
Name:LANDER, GERALD R (DDS)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:R
Last Name:LANDER
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 1:2202 ACACIA PARK DR
Mailing Address - Street 2:UNIT 2615
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3865
Mailing Address - Country:US
Mailing Address - Phone:440-460-4678
Mailing Address - Fax:
Practice Address - Street 1:2202 ACACIA PARK DR
Practice Address - Street 2:UNIT 2615
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-3865
Practice Address - Country:US
Practice Address - Phone:440-460-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0110361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice