Healthcare Provider Details

I. General information

NPI: 1295389500
Provider Name (Legal Business Name): NADIA LATIFI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MAIN STREET UNIVERSITY PEDIATRIC DENTISTRY
BUFFALO NY
14209
US

IV. Provider business mailing address

3 PEMBERTON AVENUE, PH01
TORONTO ONTARIO
M2M4M1
CA

V. Phone/Fax

Practice location:
  • Phone: 716-242-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number060629
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: