Provider Demographics
NPI:1649296054
Name:LATHAM, CELESTE ELAINE (DDS)
Entity type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:ELAINE
Last Name:LATHAM
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 1:5757 W LOVERS LN
Mailing Address - Street 2:SUITE 109
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-5166
Mailing Address - Country:US
Mailing Address - Phone:214-351-1500
Mailing Address - Fax:214-351-4104
Practice Address - Street 1:5757 W LOVERS LN
Practice Address - Street 2:SUITE 109
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-5166
Practice Address - Country:US
Practice Address - Phone:214-351-1500
Practice Address - Fax:214-351-4104
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice