Provider Demographics
NPI:1750083127
Name:MYOLI H. LANDIG D.D.S., INC.
Entity type:Organization
Organization Name:MYOLI H. LANDIG D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYOLI
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDIG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-396-5161
Mailing Address - Street 1:1241 GRAND AVE STE G
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1241 GRAND AVE STE G
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4447
Practice Address - Country:US
Practice Address - Phone:909-396-5161
Practice Address - Fax:909-396-5165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental