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General NPI Number Information
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NPI Number | 1134757446
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Entity Type | Individual
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Provider Name | JOSE RAMON MATOS LANDA DDS
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Gender | Male
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 550 POPE AVE NW STE 300
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4679
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Country | US
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Telephone | 863-345-8690
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Fax |
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Provider Business Mailing Address
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Address Line | 8767 ASHWORTH DR
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City | TAMPA
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State | FL
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Zip | 33647-2269
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Country | US
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Telephone | 813-404-7468
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN27244
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License Number State | FL
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