Provider Demographics
NPI:1508955378
Name:BARHAM, LATOYA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LATOYA
Middle Name:M
Last Name:BARHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:970 MARTIN LUTHER KING JR DR SW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-2962
Mailing Address - Country:US
Mailing Address - Phone:404-523-3153
Mailing Address - Fax:404-523-0136
Practice Address - Street 1:970 MARTIN LUTHER KING JR DR SW
Practice Address - Street 2:SUITE 301
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-2962
Practice Address - Country:US
Practice Address - Phone:404-523-3153
Practice Address - Fax:404-523-0136
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013271223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA692906293AMedicaid