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NPI Code Detail

MEDICARE: DR. CANDACE LATHAM LAUDERDALE D.M.D

MEDICARE: DR. CANDACE LATHAM LAUDERDALE D.M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDN013892GA
2122300000XDentist6174C1AL

General Provider Information

NPI Number : 1386870210
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CANDACE LATHAM LAUDERDALE D.M.D
Provider Business Mailing Address
First Line : 6783 VETERANS PKWY
Second Line : BUILDING 4
City : COLUMBUS
State : GA
Zip : 31909-3254
Country : US
Telephone Number : 706-321-3909
Fax Number :
Provider Business Practice Location Address
First Line : 6783 VETERANS PKWY
Second Line : BUILDING 4
City : COLUMBUS
State : GA
Zip : 31909-3254
Country : US
Telephone Number : 706-321-3909
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2009
Last Update Date : 05/13/2015

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