Individual
DR. LATONYA WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4727 SAINT ANTOINE ST, DETROIT, MI 48201-1461
(313) 833-7309
Mailing address
76 W ADAMS AVE APT 1604, DETROIT, MI 48226-1667
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901021345
MI
Other
Enumeration date
08/06/2014
Last updated
08/06/2014
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