Provider Demographics
NPI:1407134455
Name:NASH, LATASHA NICOLE (DMD)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:NICOLE
Last Name:NASH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9378 OLIVE BLVD
Mailing Address - Street 2:SUITE ILL
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3215
Mailing Address - Country:US
Mailing Address - Phone:314-872-3930
Mailing Address - Fax:314-872-3952
Practice Address - Street 1:13410 NEW HALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-3035
Practice Address - Country:US
Practice Address - Phone:314-830-9663
Practice Address - Fax:314-830-9664
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110203041223G0001X
IL019.0287291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice