Provider Demographics
NPI:1750803789
Name:LATORTUE, MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:LATORTUE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 BROTHERS PL SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-1523
Mailing Address - Country:US
Mailing Address - Phone:813-508-4563
Mailing Address - Fax:
Practice Address - Street 1:5 N FIRST ST
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD
Practice Address - State:MD
Practice Address - Zip Code:20640-1801
Practice Address - Country:US
Practice Address - Phone:813-508-4563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10018991223G0001X
MD165261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice