Provider Demographics
NPI:1144500091
Name:COLENBERG EAKINS, LATOYA DENISE (DMD)
Entity type:Individual
Prefix:DR
First Name:LATOYA
Middle Name:DENISE
Last Name:COLENBERG EAKINS
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 1:2045 HIGHWAY 61 N
Mailing Address - Street 2:
Mailing Address - City:PORT GIBSON
Mailing Address - State:MS
Mailing Address - Zip Code:39150-4262
Mailing Address - Country:US
Mailing Address - Phone:601-437-3050
Mailing Address - Fax:601-437-3057
Practice Address - Street 1:2045 HIGHWAY 61 N
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150
Practice Address - Country:US
Practice Address - Phone:601-437-3050
Practice Address - Fax:601-437-3057
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3615-111223G0001X
MSPENDING1223G0001X
MS3615111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice