Provider Demographics
NPI:1508945676
Name:LANDENBERGER, TRENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:
Last Name:LANDENBERGER
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 1:1001 W WILLIAMS ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3978
Mailing Address - Country:US
Mailing Address - Phone:919-362-7878
Mailing Address - Fax:919-362-6214
Practice Address - Street 1:1001 W WILLIAMS ST
Practice Address - Street 2:SUITE 105
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3978
Practice Address - Country:US
Practice Address - Phone:919-362-7878
Practice Address - Fax:919-362-6214
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice