Provider Demographics
NPI:1255649885
Name:LATHROP, MARIE (MARIE LATHROP, DMD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:LATHROP
Suffix:
Gender:F
Credentials:MARIE LATHROP, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5737 SE MILWAUKIE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4919
Mailing Address - Country:US
Mailing Address - Phone:503-232-7100
Mailing Address - Fax:503-232-4388
Practice Address - Street 1:5737 SE MILWAUKIE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-4919
Practice Address - Country:US
Practice Address - Phone:503-232-7100
Practice Address - Fax:503-232-4388
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD63911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics