Provider Demographics
NPI:1215948369
Name:LANDRY, MICHAEL J (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:LANDRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 LOUETTA ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3195
Mailing Address - Country:US
Mailing Address - Phone:281-370-8786
Mailing Address - Fax:281-894-4785
Practice Address - Street 1:9700 LOUETTA ROAD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3195
Practice Address - Country:US
Practice Address - Phone:281-370-8786
Practice Address - Fax:281-894-4785
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD12854OtherBLUE CROSS BLUE SHIELD