Provider Demographics
NPI:1568794592
Name:DIANA LATINOW DDS, MSD, PC
Entity Type:Organization
Organization Name:DIANA LATINOW DDS, MSD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:HRISTINE
Authorized Official - Last Name:LATINOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:605-765-9674
Mailing Address - Street 1:105 E BLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57442-1167
Mailing Address - Country:US
Mailing Address - Phone:605-765-9674
Mailing Address - Fax:
Practice Address - Street 1:105 E BLAINE AVE
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:SD
Practice Address - Zip Code:57442-1167
Practice Address - Country:US
Practice Address - Phone:605-765-9674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD0902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty