Provider Demographics
NPI:1518003235
Name:KARIR, LATA
Entity Type:Individual
Prefix:
First Name:LATA
Middle Name:
Last Name:KARIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 GOLF COURSE DR
Mailing Address - Street 2:APT. 138
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-4909
Mailing Address - Country:US
Mailing Address - Phone:707-540-0542
Mailing Address - Fax:
Practice Address - Street 1:4100 MONTGOMERY DR
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-5282
Practice Address - Country:US
Practice Address - Phone:707-537-2020
Practice Address - Fax:707-537-2025
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice