Provider Demographics
NPI:1306998356
Name:LANDSMAN, STANLEY LONDON (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:LONDON
Last Name:LANDSMAN
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 1:6565 WETHEROLE ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4764
Mailing Address - Country:US
Mailing Address - Phone:718-897-4545
Mailing Address - Fax:
Practice Address - Street 1:6565 WETHEROLE ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4764
Practice Address - Country:US
Practice Address - Phone:718-897-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000284280Medicaid