Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 60834 | CA |
NPI | 1003198664 |
---|---|
Provider Name | Dr. Taylor Landon |
First Address | Chesapeake, VA 23322-2499 |
Second Address | Chesapeake, VA 23322-2499 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2011 |
Last Update Date | 29/07/2016 |