# LATASHA VICK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1669456364
- **Gender:** F
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 61068 | KS | Yes |
| 363A00000X | Physician Assistant | 1061723 | OK | — |
| 363AM0700X | Medical Physician Assistant | 1061723 | OK | — |

## Other

- **Enumeration date:** 12/06/2005
- **Last updated:** 08/20/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1061723 | PA LICENSE | OK |
| 05 | — | 200022980B | — | OK |
| 05 | — | 200022980C | — | OK |