Provider Demographics
NPI:1790826865
Name:LANDAU-KENNIS, DEBRA GAIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:GAIL
Last Name:LANDAU-KENNIS
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:PO BOX 2238
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010
Mailing Address - Country:US
Mailing Address - Phone:201-943-3322
Mailing Address - Fax:
Practice Address - Street 1:537 ANDERSON STREET
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010
Practice Address - Country:US
Practice Address - Phone:201-943-3322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-09-12
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-09-12
Provider Licenses
StateLicense IDTaxonomies
NJDI140811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice