Provider Demographics
NPI:1912127598
Name:LATOCHA, CHRISTOPHER KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KEVIN
Last Name:LATOCHA
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:PO BOX 854
Mailing Address - Street 2:
Mailing Address - City:MACKINAW CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49701-0854
Mailing Address - Country:US
Mailing Address - Phone:231-436-7400
Mailing Address - Fax:231-436-7446
Practice Address - Street 1:230 W CENTRAL
Practice Address - Street 2:
Practice Address - City:MACKINAW CITY
Practice Address - State:MI
Practice Address - Zip Code:49701
Practice Address - Country:US
Practice Address - Phone:231-436-7400
Practice Address - Fax:231-436-7446
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist