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General NPI Number Information
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NPI Number | 1467836874
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Entity Type | Organization
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Legal Business Name | LATHAM PERIODONTICS
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 815 TROY SCHENECTADY RD
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City | LATHAM
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State | NY
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Zip | 12110-2445
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Country | US
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Telephone | 518-785-1067
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Fax | 518-782-9309
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Provider Business Mailing Address
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Address Line | 815 TROY SCHENECTADY RD
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City | LATHAM
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State | NY
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Zip | 12110-2445
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Country | US
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Telephone | 518-785-1067
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Fax | 518-782-9309
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JANG CHOI
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Credential | DMD
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Telephone | 518-785-1067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 051459
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License Number State | NY
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