Provider Demographics
NPI:1386121671
Name:HARRIS, LATOSHA DENISE (DMD)
Entity type:Individual
Prefix:
First Name:LATOSHA
Middle Name:DENISE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LATOSHA
Other - Middle Name:DENISE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LATOSHA HARRIS, DMD
Mailing Address - Street 1:6 PORTER ST SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-4569
Mailing Address - Country:US
Mailing Address - Phone:706-728-6423
Mailing Address - Fax:
Practice Address - Street 1:19 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546-3433
Practice Address - Country:US
Practice Address - Phone:706-896-1204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0156821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice