Randy James Landa, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11837 Issued in MN

Practice address

12805 Highway 55
Suite 100
Plymouth, MN 55441-3859

Phone

(763) 559-0775

Fax

(763) 559-0776

NPI assigned

Nov 13, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639240161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12805 HIGHWAY 55",
            "address_2": "SUITE 100",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554413859",
            "telephone_number": "763-559-0775",
            "fax_number": "763-559-0776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12805 HIGHWAY 55",
            "address_2": "SUITE 100",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554413859",
            "telephone_number": "763-559-0775",
            "fax_number": "763-559-0776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDA",
        "first_name": "RANDY",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "11837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Elizabeth Lamb, MS CCC-SLP
• Breanna Rae Lambach, DC
• Taylor Ilten Lambrecht
• Megan Marie Lampright
• Land of Lakes Orthotics & Prosthetics
• Jill Landecker, PHARM.D.
• George Harold Landis, MD
• Kristeen Joanne Laplant Young, LPCC, LADC
• Jessica Lynn Larkin, D.C.
• Kelly Jean Larsgard

• General Practice Dentistry in Plymouth, MN
• Providers in Plymouth, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.