Provider Demographics
NPI:1285709089
Name:GILLETT, LANDON PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:LANDON
Middle Name:PAUL
Last Name:GILLETT
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 1:812 E 47TH STREET
Mailing Address - Street 2:UNIT A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751
Mailing Address - Country:US
Mailing Address - Phone:512-489-0474
Mailing Address - Fax:512-458-3033
Practice Address - Street 1:5307-A AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751
Practice Address - Country:US
Practice Address - Phone:512-489-0474
Practice Address - Fax:512-458-3033
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice