Provider Demographics
NPI:1518403997
Name:LANDMARK DENTAL
Entity Type:Organization
Organization Name:LANDMARK DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:Y,
Authorized Official - Last Name:JUE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:661-399-5539
Mailing Address - Street 1:1023 N CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-3516
Mailing Address - Country:US
Mailing Address - Phone:661-399-5539
Mailing Address - Fax:661-399-5535
Practice Address - Street 1:1023 N CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-3516
Practice Address - Country:US
Practice Address - Phone:661-399-5539
Practice Address - Fax:661-399-5535
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANDMARK DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41430261QD0000X
CA33650261QD0000X
CA60937261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558427252OtherDENTIST GENERAL
CA1730523879OtherDENTIST GENERAL
CA1295025930OtherDENTIST GENERAL