Provider Demographics
NPI:1871752113
Name:LATINOVICH, RADE (DDS)
Entity type:Individual
Prefix:DR
First Name:RADE
Middle Name:
Last Name:LATINOVICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2942
Mailing Address - Country:US
Mailing Address - Phone:414-645-7372
Mailing Address - Fax:
Practice Address - Street 1:2723 W FOREST HOME AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-2942
Practice Address - Country:US
Practice Address - Phone:414-645-7372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3506122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist