Provider Demographics
NPI:1700082930
Name:LATTA SMILES
Entity Type:Organization
Organization Name:LATTA SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAEFORD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CLANTON
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-752-7655
Mailing Address - Street 1:203 S MARION ST
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-1522
Mailing Address - Country:US
Mailing Address - Phone:843-752-7655
Mailing Address - Fax:843-752-4500
Practice Address - Street 1:203 S MARION ST
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-1522
Practice Address - Country:US
Practice Address - Phone:843-752-7655
Practice Address - Fax:843-752-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1920122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty