Provider Demographics
NPI:1982036471
Name:LATHAM, JASON DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DAVID
Last Name:LATHAM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 59TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2027
Mailing Address - Country:US
Mailing Address - Phone:423-322-6805
Mailing Address - Fax:
Practice Address - Street 1:15640 REDMOND WAY
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3831
Practice Address - Country:US
Practice Address - Phone:425-224-7592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60402432122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist