Elise Marie De Latour, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DNF000450 Issued in GA

Practice address

1430 John Wesley Gilbert Drive
Augusta, GA 30912-0001

Phone

(706) 721-2371

Fax

(706) 721-6778

NPI assigned

Jun 19, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Elise Marie Hartmann Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1235511858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 JOHN WESLEY GILBERT DRIVE",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309120001",
            "telephone_number": "706-721-2371",
            "fax_number": "706-721-6778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 JOHN WESLEY GILBERT DRIVE",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309120001",
            "telephone_number": "706-721-2371",
            "fax_number": "706-721-6778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LATOUR",
        "first_name": "ELISE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-19",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN24440",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DNF000450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELISE",
            "last_name": "HARTMANN",
            "middle_name": "MARIE",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Erin Day
• Katie Teresa Day, M.ED CCC-SLP
• Lillian Marie Day, MD
• Thomas E Day, D.D.S.
• DDJ1 LLC
• Jamie Ann De Stefano, DMD, PHD
• Willem Jefferson De Vries
• Judson Benjamin Deal, DMD
• Karla N. Deal, PT
• Jennifer Dean, APRN, CPNP

• General Practice Dentistry in Augusta, GA
• Providers in Augusta, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.