Provider Demographics
NPI:1255329397
Name:LAROSILIERE, PATRICK B (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:B
Last Name:LAROSILIERE
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 1:5805 SILVER HILL RD
Mailing Address - Street 2:# G
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1168
Mailing Address - Country:US
Mailing Address - Phone:301-568-8444
Mailing Address - Fax:301-568-8447
Practice Address - Street 1:5805 SILVER HILL RD
Practice Address - Street 2:# G
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-1168
Practice Address - Country:US
Practice Address - Phone:301-568-8444
Practice Address - Fax:301-568-8447
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12811122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407170100Medicaid
MD401712900Medicaid