Provider Demographics
NPI:1861483224
Name:LANDAU, MACE JACK (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:MACE
Middle Name:JACK
Last Name:LANDAU
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 QUAIL HOLLOW CIR SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2323
Mailing Address - Country:US
Mailing Address - Phone:330-856-3443
Mailing Address - Fax:
Practice Address - Street 1:8720 E MARKET ST
Practice Address - Street 2:#8
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2364
Practice Address - Country:US
Practice Address - Phone:330-856-9199
Practice Address - Fax:330-856-3307
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300118471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry