Healthcare Provider Details

I. General information

NPI: 1487572277
Provider Name (Legal Business Name): GIANNA LATELLA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 BROAD ST
RED BANK NJ
07701-2012
US

IV. Provider business mailing address

252 BROAD ST
RED BANK NJ
07701-2012
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-2022
  • Fax:
Mailing address:
  • Phone: 732-747-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03158200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: