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General NPI Number Information
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NPI Number | 1447912860
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Entity Type | Individual
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Provider Name | SUZIE LEE LATOUR DDS, MS, MA
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Gender | Female
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 1821 S VALLEY MILLS DR STE 195
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City | WACO
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State | TX
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Zip | 76711-2123
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Country | US
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Telephone | 254-870-1440
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Fax |
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Provider Business Mailing Address
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Address Line | 8928 RANGER SUMMIT RD
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City | TEMPLE
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State | TX
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Zip | 76502-6744
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Country | US
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Telephone | 423-834-1983
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 41146
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License Number State | TX
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