Provider Demographics
NPI:1528075231
Name:LANDA, SAMUEL L (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:L
Last Name:LANDA
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 1:310 MARTELLAGO DR
Mailing Address - Street 2:
Mailing Address - City:NORTH VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34275-6706
Mailing Address - Country:US
Mailing Address - Phone:203-889-7421
Mailing Address - Fax:
Practice Address - Street 1:2350 SCENIC DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-1510
Practice Address - Country:US
Practice Address - Phone:203-889-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0079771223G0001X
FLDN205451223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice