Healthcare Provider Details

I. General information

NPI: 1730779505
Provider Name (Legal Business Name): ZACHARY DAVID LANDGRAF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 WOOD ROAD, BUILDING 1, 4TH FLOOR
FPO AA
20889
US

IV. Provider business mailing address

8955 WOOD ROAD, BUILDING 1, 4TH FLOOR
FPO AA
20889
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-0064
  • Fax:
Mailing address:
  • Phone: 301-295-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11392
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: