Provider Demographics
NPI:1184626319
Name:LANDAU, EDWARD D (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:D
Last Name:LANDAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VILLAGE ROW
Mailing Address - Street 2:LOGAN SQUARE
Mailing Address - City:NEW HOPE
Mailing Address - State:PA
Mailing Address - Zip Code:18938-1061
Mailing Address - Country:US
Mailing Address - Phone:215-862-6400
Mailing Address - Fax:215-862-7100
Practice Address - Street 1:1 VILLAGE ROW
Practice Address - Street 2:LOGAN SQUARE
Practice Address - City:NEW HOPE
Practice Address - State:PA
Practice Address - Zip Code:18938-1061
Practice Address - Country:US
Practice Address - Phone:215-862-6400
Practice Address - Fax:215-862-7100
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-11-16
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
PADS21617L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA115252OtherBLUE SHIELD PROVIDER NUMB