Provider Demographics
NPI:1659982817
Name:LANDY, HALLIE ROSE (DMD)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:ROSE
Last Name:LANDY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 CHESTNUT ST UNIT 1426
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-3138
Mailing Address - Country:US
Mailing Address - Phone:516-314-1531
Mailing Address - Fax:
Practice Address - Street 1:2101 CHESTNUT ST UNIT 1426
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3138
Practice Address - Country:US
Practice Address - Phone:516-314-1531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN246371223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty