Provider Demographics
NPI:1417027228
Name:LATINI, RENATO RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RENATO
Middle Name:RICHARD
Last Name:LATINI
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 1:51 W KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT EPHRAIM
Mailing Address - State:NJ
Mailing Address - Zip Code:08059-1304
Mailing Address - Country:US
Mailing Address - Phone:856-931-5255
Mailing Address - Fax:
Practice Address - Street 1:51 W KINGS HWY
Practice Address - Street 2:
Practice Address - City:MOUNT EPHRAIM
Practice Address - State:NJ
Practice Address - Zip Code:08059-1304
Practice Address - Country:US
Practice Address - Phone:856-931-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI009002001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice