Provider Demographics
NPI:1679252357
Name:CONNOR, LATASHA S (RDH, PHDHP, BS-DH)
Entity Type:Individual
Prefix:MRS
First Name:LATASHA
Middle Name:S
Last Name:CONNOR
Suffix:
Gender:F
Credentials:RDH, PHDHP, BS-DH
Other - Prefix:
Other - First Name:LATASHA
Other - Middle Name:S
Other - Last Name:EGGLESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2025 STRATHMORE DR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8228
Mailing Address - Country:US
Mailing Address - Phone:610-504-3748
Mailing Address - Fax:
Practice Address - Street 1:2025 STRATHMORE DR
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-8228
Practice Address - Country:US
Practice Address - Phone:610-504-3748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH067600124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist