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General NPI Number Information
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NPI Number | 1659749679
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Entity Type | Individual
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Provider Name | JASON LANDINO DMD
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Gender | Male
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Dates
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Enumeration Date | 09/08/2015
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 3702 SEA MOUNTAIN HWY
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City | LITTLE RIVER
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State | SC
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Zip | 29566
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Country | US
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Telephone | 843-734-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 269 CABLE LAKE CIRCLE
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City | CAROLINA SHORES
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State | NC
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Zip | 28467
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Country | US
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Telephone | 203-671-7562
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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 | DGD.8741 GD
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0442000255
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License Number State | VA
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