| C. Randy Landis, Dds, Inc. | |
|
80 Declaration Dr Suite 101 Chico CA 95973-4913 | |
| (530) 893-3912 | |
| (530) 893-2451 |
| Full Name | C. Randy Landis, Dds, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 80 Declaration Dr, Chico, California |
| Authorized Official Name and Position | Charles Randy Landis (PRESIDENT/OWNER) |
| Authorized Official Contact | 5308933912 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| C. Randy Landis, Dds, Inc. 80 Declaration Dr Suite 101 Chico CA 95973-4913 Ph: (530) 893-3912 | C. Randy Landis, Dds, Inc. 80 Declaration Dr Suite 101 Chico CA 95973-4913 Ph: (530) 893-3912 |
| NPI Number | 1306071758 |
|---|---|
| Provider Enumeration Date | 05/28/2009 |
| Last Update Date | 11/03/2015 |
| Medicare PECOS PAC ID | 3779746227 |
|---|---|
| Medicare Enrollment ID | O20120518000557 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306071758 | NPI | - | NPPES |
| B31940 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 31940 (California) | Primary |
| Provider Name | Charles Landis |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1063584399 PECOS PAC ID: 5496918948 Enrollment ID: I20120518000587 |
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