Provider Demographics
NPI:1205840923
Name:LATHAM, GALIN (DDS)
Entity Type:Individual
Prefix:
First Name:GALIN
Middle Name:
Last Name:LATHAM
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 1:3333 NORTH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-5041
Mailing Address - Country:US
Mailing Address - Phone:409-838-3800
Mailing Address - Fax:409-838-0920
Practice Address - Street 1:3333 NORTH ST
Practice Address - Street 2:SUITE B
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-5041
Practice Address - Country:US
Practice Address - Phone:409-838-3800
Practice Address - Fax:409-838-0920
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice