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General NPI Number Information
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NPI Number | 1033736368
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Entity Type | Individual
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Provider Name | LANDON THOMAS CASE DDS
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Gender | Male
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 10729 TOWN SQUARE DRIVE NE STE 100
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City | BLAINE
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State | MN
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Zip | 55449
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Country | US
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Telephone | 763-225-1865
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 UNIVERSITY AVE W APT 407
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City | SAINT PAUL
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State | MN
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Zip | 55114-2026
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D14390
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License Number State | MN
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