Healthcare Provider Details

I. General information

NPI: 1184626319
Provider Name (Legal Business Name): EDWARD D. LANDAU D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

1 VILLAGE ROW LOGAN SQUARE
NEW HOPE PA
18938-1061
US

IV. Provider business mailing address

1 VILLAGE ROW LOGAN SQUARE
NEW HOPE PA
18938-1061
US

V. Phone/Fax

Practice location:
  • Phone: 215-862-6400
  • Fax: 215-862-7100
Mailing address:
  • Phone: 215-862-6400
  • Fax: 215-862-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS21617L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: