Provider Demographics
NPI:1962034769
Name:STRAITS AREA DENTAL PC
Entity Type:Organization
Organization Name:STRAITS AREA DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:LATOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-548-7400
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:ALANSON
Mailing Address - State:MI
Mailing Address - Zip Code:49706-0232
Mailing Address - Country:US
Mailing Address - Phone:231-548-7400
Mailing Address - Fax:231-548-7401
Practice Address - Street 1:7700 S. HIGHWAY US 31
Practice Address - Street 2:
Practice Address - City:ALANSON
Practice Address - State:MI
Practice Address - Zip Code:49706
Practice Address - Country:US
Practice Address - Phone:231-548-7400
Practice Address - Fax:231-548-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty