Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 047717 | NY |
Y | 122300000X | Dentist | 5038 | NV |
NPI | 1003892126 |
---|---|
Provider Name | Dr. Joan Landron |
First Address | Las Vegas, NV 89106-4043 |
Second Address | Las Vegas, NV 89110-5320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 20/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02043089 | (05) | NY |
1003892126 | (05) | NV |