Provider Demographics
NPI:1386870210
Name:LAUDERDALE, CANDACE LATHAM (DMD)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:LATHAM
Last Name:LAUDERDALE
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 1:6783 VETERANS PKWY
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3254
Mailing Address - Country:US
Mailing Address - Phone:706-321-3909
Mailing Address - Fax:
Practice Address - Street 1:6783 VETERANS PKWY
Practice Address - Street 2:BUILDING 4
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3254
Practice Address - Country:US
Practice Address - Phone:706-321-3909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013892122300000X
AL6174C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist