Healthcare Provider Details

I. General information

NPI: 1568637064
Provider Name (Legal Business Name): KEVIN G. LANDON, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 EL DORADO ST
MONTEREY CA
93940-4606
US

IV. Provider business mailing address

333 EL DORADO ST
MONTEREY CA
93940-4606
US

V. Phone/Fax

Practice location:
  • Phone: 831-375-4014
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number24311
License Number StateCA

VIII. Authorized Official

Name: DR. KEVIN G. LANDON
Title or Position: DENTIST
Credential: DDS
Phone: 831-375-4014