MEDICARE: SAM M LATIF DMD

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	1223G0001X	General Practice Dentistry	30017747	OH

General Provider Information

NPI Number	:	1912189598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAM M LATIF DMD

Provider Business Mailing Address
First Line	:	1010 BETHEL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214
Country	:	US
Telephone Number	:	614-459-7300
Fax Number	:	614-459-9095

Provider Business Practice Location Address
First Line	:	1010 BETHEL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214
Country	:	US
Telephone Number	:	614-459-7300
Fax Number	:	614-459-9095

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

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	10/23/2025

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