Provider Demographics
NPI:1366543415
Name:LANDER, TODD (DMD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:LANDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11275 E MISSISSIPPI AVE
Mailing Address - Street 2:SUITE #2W1
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3263
Mailing Address - Country:US
Mailing Address - Phone:303-364-7631
Mailing Address - Fax:303-364-1107
Practice Address - Street 1:11275 E MISSISSIPPI AVE
Practice Address - Street 2:SUITE #2W1
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3263
Practice Address - Country:US
Practice Address - Phone:303-364-7631
Practice Address - Fax:303-364-1107
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO65171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice