Healthcare Provider Details

I. General information

NPI: 1659289288
Provider Name (Legal Business Name): LAT DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 PIEDMONT ST SE
ROANOKE VA
24014-1223
US

IV. Provider business mailing address

1113 PIEDMONT ST SE
ROANOKE VA
24014-1223
US

V. Phone/Fax

Practice location:
  • Phone: 540-892-0968
  • Fax: 540-904-4030
Mailing address:
  • Phone: 540-904-4020
  • Fax: 540-904-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDSAY THORN
Title or Position: OWNER
Credential: DMD
Phone: 540-892-0968