MEDICARE: DR. LANDON PAUL GILLETT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22681	TX

General Provider Information

NPI Number	:	1285709089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LANDON PAUL GILLETT DDS

Provider Business Mailing Address
First Line	:	812 E 47TH STREET
Second Line	:	UNIT A
City	:	AUSTIN
State	:	TX
Zip	:	78751
Country	:	US
Telephone Number	:	512-489-0474
Fax Number	:	512-458-3033

Provider Business Practice Location Address
First Line	:	5307-A AIRPORT BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751
Country	:	US
Telephone Number	:	512-489-0474
Fax Number	:	512-458-3033

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	11/23/2020

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