Organization
C. RANDY LANDIS, DDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES RANDY LANDIS DDS,OMS (PRESIDENT/OWNER)
(530) 893-3912
Entity
Organization
Contact information
Practice address
80 DECLARATION DR, SUITE 101, CHICO, CA 95973-4913
(530) 893-3912
(530) 893-2451
Mailing address
80 DECLARATION DR, SUITE 101, CHICO, CA 95973-4913
(530) 893-3912
(530) 893-2451
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
31940
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B31940
—
CA
Enumeration date
05/28/2009
Last updated
11/03/2015
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