Provider Demographics
NPI:1275601809
Name:LATTUCA KELLY, JANINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANINE
Middle Name:
Last Name:LATTUCA KELLY
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 1:22 HOWARD BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MT ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07856-1532
Mailing Address - Country:US
Mailing Address - Phone:973-770-1700
Mailing Address - Fax:973-770-1800
Practice Address - Street 1:22 HOWARD BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:MR ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07856
Practice Address - Country:US
Practice Address - Phone:973-770-1700
Practice Address - Fax:973-770-1800
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01925900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist