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General NPI Number Information
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NPI Number | 1427226984
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Entity Type | Organization
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Legal Business Name | J. RANDALL LATTA, DDS & ASSOCIATES, PA
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Dates
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Enumeration Date | 02/18/2008
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Last Update Date | 02/18/2008
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Provider Practice Location Address
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Address Line | 3179 SWEETEN CREEK RD SUITE D
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City | ASHEVILLE
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State | NC
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Zip | 28803-2115
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Country | US
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Telephone | 252-305-1286
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1110
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City | ASHEVILLE
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State | NC
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Zip | 28802-1110
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Country | US
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Telephone | 252-305-1286
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. J. RANDALL LATTA
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Credential | DDS
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Telephone | 252-305-1286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4081
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License Number State | NC
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