Provider Demographics
NPI:1073380978
Name:DR LAROSLIERE DDS - BALTIMORE INC
Entity Type:Organization
Organization Name:DR LAROSLIERE DDS - BALTIMORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-603-4800
Mailing Address - Street 1:1001 N POINT BLVD STE 503
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3413
Mailing Address - Country:US
Mailing Address - Phone:410-282-8900
Mailing Address - Fax:
Practice Address - Street 1:1001 N POINT BLVD STE 503
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3413
Practice Address - Country:US
Practice Address - Phone:410-282-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty