Provider Demographics
NPI:1083704209
Name:LATIOLAIS, TERRY JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:JOSEPH
Last Name:LATIOLAIS
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 1:2900 MOSS ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501
Mailing Address - Country:US
Mailing Address - Phone:337-233-2105
Mailing Address - Fax:337-233-2593
Practice Address - Street 1:2900 MOSS ST
Practice Address - Street 2:SUITE E
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501
Practice Address - Country:US
Practice Address - Phone:337-233-2105
Practice Address - Fax:337-233-2593
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist