MEDICARE: MATTHEW ALAN LANDIN DMD

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	DS041387	PA

General Provider Information

NPI Number	:	1558886481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ALAN LANDIN DMD

Provider Business Mailing Address
First Line	:	PO BOX 597
Second Line	:
City	:	SUGAR GROVE
State	:	PA
Zip	:	16350-0597
Country	:	US
Telephone Number	:	814-489-7862
Fax Number	:	814-489-7862

Provider Business Practice Location Address
First Line	:	12605 JACKSON RUN RD
Second Line	:
City	:	SUGAR GROVE
State	:	PA
Zip	:	16350-1635
Country	:	US
Telephone Number	:	814-489-7862
Fax Number	:	814-489-7862

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

Provider Enumeration Date	:	08/11/2017
Last Update Date	:	08/03/2021

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