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NPI Code Detail

MEDICARE: DR. GREGORY SCOTT LATUS DDS

MEDICARE: DR. GREGORY SCOTT LATUS DDS
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
1122300000XDentist30.023696OH
2122300000XDentistD14641MN

General Provider Information

NPI Number : 1154682730
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY SCOTT LATUS DDS
Provider Business Mailing Address
First Line : 6721 MADISON ST NE
Second Line :
City : FRIDLEY
State : MN
Zip : 55432-4450
Country : US
Telephone Number : 414-588-7096
Fax Number :
Provider Business Practice Location Address
First Line : 1670 BEAM AVE STE 204
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-1227
Country : US
Telephone Number : 651-925-8400
Fax Number : 651-773-7568
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2012
Last Update Date : 12/22/2021

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