Provider Demographics
NPI:1922789304
Name:LATIF, LUPA JAHAN (DMD)
Entity Type:Individual
Prefix:
First Name:LUPA
Middle Name:JAHAN
Last Name:LATIF
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-1845
Mailing Address - Country:US
Mailing Address - Phone:203-934-3400
Mailing Address - Fax:
Practice Address - Street 1:910 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1845
Practice Address - Country:US
Practice Address - Phone:203-934-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT138721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice