Provider Demographics
NPI:1477129146
Name:LATIF, TAMARA (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:LATIF
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 1:3341 WARRENSVILLE CENTER RD APT 302
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3720
Mailing Address - Country:US
Mailing Address - Phone:304-906-9225
Mailing Address - Fax:
Practice Address - Street 1:26300 EUCLID AVE STE 610
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3703
Practice Address - Country:US
Practice Address - Phone:216-916-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0263931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics