Provider Demographics
NPI:1801012182
Name:LATHAM, ALLEN STEVENSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:STEVENSON
Last Name:LATHAM
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 1:751 STERLING PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-8690
Mailing Address - Country:US
Mailing Address - Phone:916-543-2859
Mailing Address - Fax:916-543-2879
Practice Address - Street 1:751 STERLING PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-8690
Practice Address - Country:US
Practice Address - Phone:916-543-2859
Practice Address - Fax:916-543-2879
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice