Provider Demographics
NPI:1982020665
Name:LATER DENTAL
Entity Type:Organization
Organization Name:LATER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:JANETH
Authorized Official - Last Name:CARREON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-381-1888
Mailing Address - Street 1:5132 VILLAGE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4497
Mailing Address - Country:US
Mailing Address - Phone:972-381-1888
Mailing Address - Fax:
Practice Address - Street 1:5132 VILLAGE CREEK DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4497
Practice Address - Country:US
Practice Address - Phone:972-381-1888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty