Healthcare Provider Details

I. General information

NPI: 1104753748
Provider Name (Legal Business Name): LATHAM SMILES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 TROY SCHENECTADY RD
LATHAM NY
12110-3425
US

IV. Provider business mailing address

216 TROY SCHENECTADY RD
LATHAM NY
12110-3425
US

V. Phone/Fax

Practice location:
  • Phone: 518-782-9015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLIE BEAN
Title or Position: REGIONAL MANAGER
Credential:
Phone: 518-813-1952