Provider Demographics
NPI:1174651889
Name:LATOUCHE, THOMAS MOSES
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MOSES
Last Name:LATOUCHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:
Other - Last Name:LATOUCHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:116 W SPOTSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22827-1119
Mailing Address - Country:US
Mailing Address - Phone:540-298-9419
Mailing Address - Fax:
Practice Address - Street 1:116 W SPOTSWOOD AVE
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:VA
Practice Address - Zip Code:22827-1119
Practice Address - Country:US
Practice Address - Phone:540-298-9419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010054561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice