Provider Demographics
NPI:1265493746
Name:BERI, LATA GATHWALA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:LATA
Middle Name:GATHWALA
Last Name:BERI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10496 GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733
Mailing Address - Country:US
Mailing Address - Phone:626-442-5678
Mailing Address - Fax:626-442-4377
Practice Address - Street 1:10496 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733
Practice Address - Country:US
Practice Address - Phone:626-442-5678
Practice Address - Fax:626-442-4377
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist