Healthcare Provider Details

I. General information

NPI: 1629143748
Provider Name (Legal Business Name): JAMES LEE LANDERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MILWAUKEE DR
COEUR D ALENE ID
83814-2236
US

IV. Provider business mailing address

801 N. WILWAUKEE
COEUR D ALENE ID
83814
US

V. Phone/Fax

Practice location:
  • Phone: 208-664-0884
  • Fax: 208-664-3304
Mailing address:
  • Phone: 208-664-0884
  • Fax: 208-664-3304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD1647
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: