Provider Demographics
NPI:1154517084
Name:THAMPY, LATA MATHEW (DMD)
Entity type:Individual
Prefix:DR
First Name:LATA
Middle Name:MATHEW
Last Name:THAMPY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1894
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27512
Mailing Address - Country:US
Mailing Address - Phone:857-939-0676
Mailing Address - Fax:
Practice Address - Street 1:1201 CROSSROADS MANOR CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518
Practice Address - Country:US
Practice Address - Phone:857-939-0676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57947122300000X
NC0699122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist