Healthcare Provider Details

I. General information

NPI: 1356834675
Provider Name (Legal Business Name): GENNADY LANDA, DDS, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44441 16TH ST W STE 103
LANCASTER CA
93534-2873
US

IV. Provider business mailing address

44441 16TH ST W STE 103
LANCASTER CA
93534-2873
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-4040
  • Fax: 661-945-9120
Mailing address:
  • Phone: 661-945-4040
  • Fax: 661-945-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GENNADY LANDA
Title or Position: PRESIDENT
Credential: DDS, MD
Phone: 818-970-0253