Provider Demographics
NPI:1518077833
Name:LAROTTA, LINA E (DMD)
Entity Type:Individual
Prefix:DR
First Name:LINA
Middle Name:E
Last Name:LAROTTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70344
Mailing Address - Street 2:PMB 368
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-764-1590
Mailing Address - Fax:787-754-4363
Practice Address - Street 1:368 CALLE DE DIEGO
Practice Address - Street 2:OFIC. C-6
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-2916
Practice Address - Country:US
Practice Address - Phone:787-764-1590
Practice Address - Fax:787-754-4363
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice