Provider Demographics
NPI:1023793924
Name:HAJJE, LANDEN
Entity type:Individual
Prefix:DR
First Name:LANDEN
Middle Name:
Last Name:HAJJE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 FREEDOM CIR
Mailing Address - Street 2:
Mailing Address - City:NOLANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76559-2556
Mailing Address - Country:US
Mailing Address - Phone:806-382-7237
Mailing Address - Fax:
Practice Address - Street 1:602 E BUSINESS 190
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2956
Practice Address - Country:US
Practice Address - Phone:254-547-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist