MEDICARE: LATHAM SMILES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1104753748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LATHAM SMILES LLC

Provider Business Mailing Address
First Line	:	216 TROY SCHENECTADY RD
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-3425
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 TROY SCHENECTADY RD
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-3425
Country	:	US
Telephone Number	:	518-782-9015
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL MANAGER
Name	:	KELLIE BEAN
Credential	:
Telephone Number	:	518-813-1952

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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Directions to “LATHAM SMILES LLC ” Practice Location

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