Individual
DR. JASON MASCHAL LANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
1607 E RAINFOREST DR, FAYETTEVILLE, AR 72703-5385
(479) 582-0600
(479) 443-4630
Mailing address
1607 E RAINFOREST DR, FAYETTEVILLE, AR 72703-5385
(479) 582-0600
(479) 443-4630
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
154
OK
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
3412
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200046160A
SOONERCARE - INDIVIDUAL
OK
01
—
5A640
BCBS - INDIVIDUAL
AR
Enumeration date
04/26/2007
Last updated
12/09/2013
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