Provider Demographics
NPI:1588333249
Name:LATTERI, EMILY JEAN (DMD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JEAN
Last Name:LATTERI
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 1:535 ERICA
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-1148
Mailing Address - Country:US
Mailing Address - Phone:931-538-5773
Mailing Address - Fax:
Practice Address - Street 1:3850 S NEW BRAUNFELS AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-1709
Practice Address - Country:US
Practice Address - Phone:254-845-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX378381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice