Provider Demographics
NPI:1639240161
Name:LANDA, RANDY JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:JAMES
Last Name:LANDA
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 1:12805 HIGHWAY 55
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-3859
Mailing Address - Country:US
Mailing Address - Phone:763-559-0775
Mailing Address - Fax:763-559-0776
Practice Address - Street 1:12805 HIGHWAY 55
Practice Address - Street 2:SUITE 100
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3859
Practice Address - Country:US
Practice Address - Phone:763-559-0775
Practice Address - Fax:763-559-0776
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice