Provider Demographics
NPI:1063483444
Name:CABASSA LATONI, ROBERTO JOAQUIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:JOAQUIN
Last Name:CABASSA LATONI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 290370
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33329-0370
Mailing Address - Country:US
Mailing Address - Phone:954-262-4346
Mailing Address - Fax:954-262-2269
Practice Address - Street 1:819 NE 26TH ST STE C
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1239
Practice Address - Country:US
Practice Address - Phone:305-484-3657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2020-03-09
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2020-02-28
Provider Licenses
StateLicense IDTaxonomies
FLDTP6951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102175000Medicaid