Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN20143 | FL |
N | 1223S0112X | Oral and Maxillofacial Surgeon | ME139628 | FL |
NPI | 1083955819 |
---|---|
Provider Name | Dr. Samuel Landrian |
First Address | New Port Richey, FL 34652-1928 |
Second Address | New Port Richey, FL 34652-1928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2013 |
Last Update Date | 10/03/2020 |