Provider Demographics
NPI:1932585296
Name:LATITUDE DENTAL
Entity Type:Organization
Organization Name:LATITUDE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:YARELIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-237-6813
Mailing Address - Street 1:3650 NW 82ND AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3650 NW 82ND AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6658
Practice Address - Country:US
Practice Address - Phone:787-237-6813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN200611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty