Healthcare Provider Details

I. General information

NPI: 1003892126
Provider Name (Legal Business Name): JOAN LANDRON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 N NELLIS BLVD
LAS VEGAS NV
89110-5320
US

IV. Provider business mailing address

526 S TONOPAH DR STE. 200
LAS VEGAS NV
89106-4043
US

V. Phone/Fax

Practice location:
  • Phone: 702-384-1010
  • Fax: 702-438-8424
Mailing address:
  • Phone: 702-291-2031
  • Fax: 702-366-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number047717
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5038
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: