Provider Demographics
NPI:1972768851
Name:LANDON, SALLY ANN (DDS)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:LANDON
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 1:3120 NASA PKWY
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-6465
Mailing Address - Country:US
Mailing Address - Phone:281-326-7117
Mailing Address - Fax:
Practice Address - Street 1:3120 NASA PKWY
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-6465
Practice Address - Country:US
Practice Address - Phone:281-326-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist