Healthcare Provider Details

I. General information

NPI: 1124879879
Provider Name (Legal Business Name): LANDON LEDINGHAM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3291 BUTLER SPAETH RD
GILLETTE WY
82718-5483
US

IV. Provider business mailing address

4402 BRORBY BLVD
GILLETTE WY
82718-9462
US

V. Phone/Fax

Practice location:
  • Phone: 307-670-8118
  • Fax:
Mailing address:
  • Phone: 801-888-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1723
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: