Individual
CHRISTOPHER WRIGHT LATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2047 PARK ST, JACKSONVILLE, FL 32204-3809
(904) 388-7665
Mailing address
2047 PARK ST, JACKSONVILLE, FL 32204-3809
(904) 388-7665
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
18401
FL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
56616
MN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
D12636
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
Enumeration date
07/10/2008
Last updated
09/02/2014
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