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General NPI Number Information
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NPI Number | 1942532692
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Entity Type | Individual
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Provider Name | LATOI RAPHAEL THOMAS D.D.S
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Gender | Female
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Dates
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Enumeration Date | 02/05/2010
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 430 DIXIE HWY
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-1799
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Country | US
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Telephone | 708-808-4950
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Fax |
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Provider Business Mailing Address
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Address Line | 16 HICKORY CT
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City | CALUMET CITY
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State | IL
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Zip | 60409-5013
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Country | US
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Telephone | 312-391-1913
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019028142
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License Number State | IL
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