Provider Demographics
NPI:1164534715
Name:LATNER, LESLIE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:E
Last Name:LATNER
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 1:2990 S SEPULVEDA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3973
Mailing Address - Country:US
Mailing Address - Phone:310-477-1081
Mailing Address - Fax:310-478-4067
Practice Address - Street 1:2990 S SEPULVEDA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3973
Practice Address - Country:US
Practice Address - Phone:310-477-1081
Practice Address - Fax:310-478-4067
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice