Provider Demographics
NPI:1023037884
Name:LATOURELLE, MICHAEL D (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:LATOURELLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610
Mailing Address - Country:US
Mailing Address - Phone:610-927-6441
Mailing Address - Fax:610-741-6914
Practice Address - Street 1:951 PENN AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610
Practice Address - Country:US
Practice Address - Phone:610-927-6441
Practice Address - Fax:610-741-6914
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036076122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist