Individual
DR. PHILLIP T LATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4488 W BROAD ST, COLUMBUS, OH 43228-5610
(614) 878-7778
(614) 878-2725
Mailing address
4488 W BROAD ST, COLUMBUS, OH 43228-5610
(614) 878-7778
(614) 878-2725
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
30013309
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000116964
ANTHEM BCBS
OH
05
—
0417794
—
OH
Enumeration date
12/28/2006
Last updated
07/09/2007
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