Provider Demographics
NPI:1598171555
Name:LATHAM, THAO TRANG NGOC (DMD)
Entity Type:Individual
Prefix:DR
First Name:THAO TRANG
Middle Name:NGOC
Last Name:LATHAM
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 1:3100 ASHLEY TOWN CENTER DR
Mailing Address - Street 2:APT 341
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5682
Mailing Address - Country:US
Mailing Address - Phone:864-906-6179
Mailing Address - Fax:
Practice Address - Street 1:114 BOYCE LAWTON DR
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:SC
Practice Address - Zip Code:29030
Practice Address - Country:US
Practice Address - Phone:803-823-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist