MEDICARE: LATOSHA DENT

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP60903459	WA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95010715	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578033593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOSHA DENT

Provider Business Mailing Address
First Line	:	1812 W BURBANK BLVD # 5300
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-1315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 W BURBANK BLVD # 5300
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-1315
Country	:	US
Telephone Number	:	206-430-8118
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2018
Last Update Date	:	07/20/2020

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Directions to “ LATOSHA DENT ” Practice Location

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