Provider Demographics
NPI:1679596472
Name:LATZ, DAVID LESTER (DDS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LESTER
Last Name:LATZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 SHIRLEY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49284
Mailing Address - Country:US
Mailing Address - Phone:517-787-2516
Mailing Address - Fax:517-787-7734
Practice Address - Street 1:2633 SHIRLEY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201
Practice Address - Country:US
Practice Address - Phone:517-787-2516
Practice Address - Fax:517-787-7734
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI110831223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice