Provider Demographics
NPI:1871150326
Name:LAROSILIERE AND ASSOCIATES DENTAL CARE, PA
Entity type:Organization
Organization Name:LAROSILIERE AND ASSOCIATES DENTAL CARE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAROSILIERE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-610-5690
Mailing Address - Street 1:2345 MARTIN LUTHER KING JR AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5821
Mailing Address - Country:US
Mailing Address - Phone:202-610-5690
Mailing Address - Fax:202-610-5696
Practice Address - Street 1:2345 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5821
Practice Address - Country:US
Practice Address - Phone:202-610-5690
Practice Address - Fax:202-610-5696
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAROSILIERE AND ASSOCIATES DENTAL CARE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC040862800Medicaid