Provider Demographics
NPI:1306415245
Name:CRITES, CHANCE LATHAM (DMD)
Entity Type:Individual
Prefix:
First Name:CHANCE
Middle Name:LATHAM
Last Name:CRITES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-2635
Mailing Address - Country:US
Mailing Address - Phone:662-563-9550
Mailing Address - Fax:
Practice Address - Street 1:310 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2635
Practice Address - Country:US
Practice Address - Phone:662-563-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4221-21122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist