Provider Demographics
NPI:1902119217
Name:LAND, AARON BRENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:BRENT
Last Name:LAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N PRESTON RD STE 40
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8893
Mailing Address - Country:US
Mailing Address - Phone:469-712-4100
Mailing Address - Fax:469-712-4100
Practice Address - Street 1:1000 N PRESTON RD STE 40
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8893
Practice Address - Country:US
Practice Address - Phone:469-712-4100
Practice Address - Fax:469-712-4100
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256911223G0001X
AZD0086431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ820357Medicaid