Provider Demographics
NPI:1922150366
Name:LANDAU, LOUIS W JR (DM D)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:W
Last Name:LANDAU
Suffix:JR
Gender:M
Credentials:DM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 VILLAGE GREEN CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2317
Mailing Address - Country:US
Mailing Address - Phone:229-435-4548
Mailing Address - Fax:229-438-5675
Practice Address - Street 1:2305 VILLAGE GREEN CT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2317
Practice Address - Country:US
Practice Address - Phone:229-435-4548
Practice Address - Fax:229-438-5675
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist