Healthcare Provider Details

I. General information

NPI: 1962952127
Provider Name (Legal Business Name): LANDA MIZIN DENTAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 W ALAMEDA AVE STE 502
BURBANK CA
91505-4816
US

IV. Provider business mailing address

2625 W ALAMEDA AVE STE 502
BURBANK CA
91505-4816
US

V. Phone/Fax

Practice location:
  • Phone: 818-845-2616
  • Fax:
Mailing address:
  • Phone: 818-845-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. GENNADY LANDA
Title or Position: PRESIDENT
Credential: DDS, MD
Phone: 818-845-2616