Provider Demographics
NPI:1306404363
Name:BARHAM, LATEN EDWARDS (DDS)
Entity Type:Individual
Prefix:DR
First Name:LATEN
Middle Name:EDWARDS
Last Name:BARHAM
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 1:38 LANE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-6570
Mailing Address - Country:US
Mailing Address - Phone:318-680-1373
Mailing Address - Fax:
Practice Address - Street 1:4351 PECANLAND MALL DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-7014
Practice Address - Country:US
Practice Address - Phone:318-582-4459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6982122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist