Provider Demographics
NPI:1508872284
Name:CARRATOLA, LOUIS MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:MICHAEL
Last Name:CARRATOLA
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 1:1704 BERLIN ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:OH
Mailing Address - Zip Code:44846-9521
Mailing Address - Country:US
Mailing Address - Phone:419-499-2472
Mailing Address - Fax:419-499-8126
Practice Address - Street 1:63 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:OH
Practice Address - Zip Code:44851-1233
Practice Address - Country:US
Practice Address - Phone:419-929-1544
Practice Address - Fax:419-929-0402
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30017312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0525079Medicaid
OH260370149027OtherCARESOURCE