Provider Demographics
NPI:1730185265
Name:LAND, MICHAEL J (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:LAND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:101 PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2563
Mailing Address - Country:US
Mailing Address - Phone:215-345-7373
Mailing Address - Fax:215-345-0242
Practice Address - Street 1:101 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2563
Practice Address - Country:US
Practice Address - Phone:215-345-7373
Practice Address - Fax:215-345-0242
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027816L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA785239Medicare ID - Type Unspecified
PAU57473Medicare UPIN