Healthcare Provider Details

I. General information

NPI: 1447267083
Provider Name (Legal Business Name): KATERYNA LATYPOVA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BENMONT AVE SUITE 21
BENNINGTON VT
05201
US

IV. Provider business mailing address

160 BENMONT AVE SUITE 21
BENNINGTON VT
05201
US

V. Phone/Fax

Practice location:
  • Phone: 802-447-3199
  • Fax: 802-447-3123
Mailing address:
  • Phone: 802-447-3199
  • Fax: 802-447-3123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number04805
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number20675
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2284
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: