Provider Demographics
NPI:1700943701
Name:LATTA, JOSEPH BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BRUCE
Last Name:LATTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1107 SLIGO CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5806
Mailing Address - Country:US
Mailing Address - Phone:301-891-7760
Mailing Address - Fax:301-891-7791
Practice Address - Street 1:1107 SLIGO CREEK PKWY
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5806
Practice Address - Country:US
Practice Address - Phone:301-891-7760
Practice Address - Fax:301-891-7791
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD54791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry