Provider Demographics
NPI:1538732615
Name:LANDREE, EMILY K (DDS)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:K
Last Name:LANDREE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 KROLL RD
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:WI
Mailing Address - Zip Code:54162
Mailing Address - Country:US
Mailing Address - Phone:224-538-0696
Mailing Address - Fax:
Practice Address - Street 1:2340 DUCK CREEK PKWY
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3300
Practice Address - Country:US
Practice Address - Phone:920-965-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002554-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice