Provider Demographics
NPI:1922881929
Name:LATOURETTE, ANITA (RDH)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:LATOURETTE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3897 MORRIS CT
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1969
Mailing Address - Country:US
Mailing Address - Phone:404-307-9827
Mailing Address - Fax:
Practice Address - Street 1:5030 GEORGIA BELLE CT STE 2071
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2667
Practice Address - Country:US
Practice Address - Phone:770-638-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH003848124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist