Provider Demographics
NPI:1912563123
Name:LATIF, JAMAL (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:
Last Name:LATIF
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 SAYBROOK CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1660
Mailing Address - Country:US
Mailing Address - Phone:614-397-5402
Mailing Address - Fax:
Practice Address - Street 1:4808 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1554
Practice Address - Country:US
Practice Address - Phone:614-261-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist