Provider Demographics
NPI:1871794735
Name:LANDMAN, CAROLE ELLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:ELLEN
Last Name:LANDMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 N LAKE SHORE DR APT 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4244
Mailing Address - Country:US
Mailing Address - Phone:773-935-1229
Mailing Address - Fax:
Practice Address - Street 1:625 N MICHIGAN AVE STE 1020
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3114
Practice Address - Country:US
Practice Address - Phone:312-266-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice