Latasha Vick, DDS
Individual provider Active NPI General Practice Dentistry · Baxter Springs, KS
NPI 1669456364 · NPPES record last updated Aug 20, 2013
Key facts
- NPI
- 1669456364
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 61068 (KS)
- Practice address
- 2990 Military Ave
Baxter Springs, KS 66713-2331 - Phone
- (620) 856-2900
- Fax
- (620) 856-2901
- NPI assigned
- Dec 6, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61068 | KS | MD | General Practice Dentistry |
| 1348 | OK | MD | Occupational Therapy Assistant |
| 1061723 | OK | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1061723 | OK | |
| Medical Physician Assistant | 363AM0700X | 1061723 | OK | |
| General Practice Dentistry | 1223G0001X | 61068 | KS | Yes |
Addresses
Primary practice location
2990 Military Ave
Baxter Springs, KS 66713-2331
Mailing address
3011 N Michigan St
Pittsburg, KS 66762-2546
Phone (620) 231-9873
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1061723 | Other | OK | PA LICENSE |
| 200022980B | Medicaid | OK | |
| 200022980C | Medicaid | OK |
Other providers in Baxter Springs, KS
- St. John'S Medical Group
- Vallerie L Sweeton
- Crystal Marie Taylor
- Audrey Nicole Thompson
- Phillip Michael Tongier
- Wal-Mart Stores Inc
- Walgreen Co
- Steven F Werder
- Daniel Wesley Williams
- Wolkar Drug Inc
All providers in Baxter Springs, KS · General Practice Dentistry in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.