Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DTP695 | FL |
NPI | 1063483444 |
---|---|
Provider Name | Dr. Roberto Joaquin Cabassa Latoni |
First Address | Ft Lauderdale, FL 33329-0370 |
Second Address | Wilton Manors, FL 33305-1239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 09/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102175000 | (05) | FL |