Provider Demographics
NPI:1942532692
Name:THOMAS, LATOI RAPHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LATOI
Middle Name:RAPHAEL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HICKORY CT
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5013
Mailing Address - Country:US
Mailing Address - Phone:312-391-1913
Mailing Address - Fax:
Practice Address - Street 1:430 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1799
Practice Address - Country:US
Practice Address - Phone:708-808-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist