Provider Demographics
NPI:1558886481
Name:LANDIN, MATTHEW ALAN (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALAN
Last Name:LANDIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:16350-0597
Mailing Address - Country:US
Mailing Address - Phone:814-489-7862
Mailing Address - Fax:814-489-7862
Practice Address - Street 1:12605 JACKSON RUN RD
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:PA
Practice Address - Zip Code:16350-1635
Practice Address - Country:US
Practice Address - Phone:814-489-7862
Practice Address - Fax:814-489-7862
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0413871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice