Provider Demographics
NPI:1861722415
Name:LANDERS, VERONICA ELBASHAB (DMD)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:ELBASHAB
Last Name:LANDERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:ELBASHAB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:8440 PIT STOP CT NW
Mailing Address - Street 2:SUITE NUMBERS A & B
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8245
Mailing Address - Country:US
Mailing Address - Phone:704-548-2700
Mailing Address - Fax:704-548-2767
Practice Address - Street 1:8440 PIT STOP CT NW
Practice Address - Street 2:SUITE NUMBERS A & B
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8245
Practice Address - Country:US
Practice Address - Phone:704-548-2700
Practice Address - Fax:704-548-2767
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist