Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1194375188 |
---|---|
Provider Name | Vincent Nevin Lattanzi |
First Address | Fort Eustis, VA 23604-1526 |
Second Address | Fort Eustis, VA 23604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2019 |
Last Update Date | 12/09/2019 |