Provider Demographics
NPI:1295891513
Name:MARTIN, LATISHA SHINTRELL (DDS)
Entity type:Individual
Prefix:DR
First Name:LATISHA
Middle Name:SHINTRELL
Last Name:MARTIN
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 1:1210 MILLERSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-6656
Mailing Address - Country:US
Mailing Address - Phone:717-299-4300
Mailing Address - Fax:
Practice Address - Street 1:1210 MILLERSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-6656
Practice Address - Country:US
Practice Address - Phone:717-299-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412769122300000X, 1223G0001X
PADS0407221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist