Provider Demographics
NPI:1699296517
Name:LANDIS, LAURA MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MICHELLE
Last Name:LANDIS
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 1:43025 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3217
Mailing Address - Country:US
Mailing Address - Phone:248-347-3700
Mailing Address - Fax:
Practice Address - Street 1:43025 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375
Practice Address - Country:US
Practice Address - Phone:248-347-3700
Practice Address - Fax:248-347-1541
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010223621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice