Provider Demographics
NPI:1609981398
Name:LANDERS, MICHAEL JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:LANDERS
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 1:1099 E CHAMPLAIN DR
Mailing Address - Street 2:S. A209
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5030
Mailing Address - Country:US
Mailing Address - Phone:559-281-5805
Mailing Address - Fax:
Practice Address - Street 1:1099 E CHAMPLAIN DR
Practice Address - Street 2:S. A209
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-5030
Practice Address - Country:US
Practice Address - Phone:559-281-5805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB321141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice