Individual
JASON LEE LATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
712 SAINT ANDREWS BLVD, CHARLESTON, SC 29407
(843) 571-5533
Mailing address
1350 SPRING ST NW STE 600, ATLANTA, GA 30309-2870
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8643
SC
Other
Enumeration date
05/09/2018
Last updated
05/15/2018
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