Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5926 | NE |
NPI | 1003954868 |
---|---|
Provider Name | Dr. David B Landgren |
First Address | Hastings, NE 68901 |
Second Address | Hastings, NE 68901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47079607200 | (05) | NE |