Provider Demographics
NPI:1447267083
Name:LATYPOVA, KATERYNA (DMD)
Entity type:Individual
Prefix:MRS
First Name:KATERYNA
Middle Name:
Last Name:LATYPOVA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BENMONT AVE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201
Mailing Address - Country:US
Mailing Address - Phone:802-447-3199
Mailing Address - Fax:802-447-3123
Practice Address - Street 1:160 BENMONT AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201
Practice Address - Country:US
Practice Address - Phone:802-447-3199
Practice Address - Fax:802-447-3123
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH048051223P0300X
MA206751223P0300X
VT22841223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0203041Medicaid