Provider Demographics
NPI:1912189598
Name:LATIF, SAM M (DMD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:M
Last Name:LATIF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4661 SAWMILL RD
Mailing Address - Street 2:102
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-6123
Mailing Address - Country:US
Mailing Address - Phone:614-459-7300
Mailing Address - Fax:614-459-9095
Practice Address - Street 1:4661 SAWMILL RD
Practice Address - Street 2:102
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-6123
Practice Address - Country:US
Practice Address - Phone:614-459-7300
Practice Address - Fax:614-459-9095
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300177471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice