Organization
IMAGINE SMILES PLLC
Active
Other names
Parkview Kids Dental & Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
THAO LATHAM DMD (OWNER)
(864) 906-6179
Entity
Organization
Contact information
Practice address
13205 REAMS RD UNIT 164, WINDERMERE, FL 34786
(864) 906-6179
Mailing address
5259 ARIVA DR APT 101, LAKELAND, FL 33812-4436
(864) 906-6179
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
04/15/2021
Last updated
04/15/2021
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