MEDICARE: DR. CHRISTOPHER KEVIN LATOCHA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	16009	MI

General Provider Information

NPI Number	:	1912127598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER KEVIN LATOCHA DDS

Provider Business Mailing Address
First Line	:	PO BOX 854
Second Line	:
City	:	MACKINAW CITY
State	:	MI
Zip	:	49701-0854
Country	:	US
Telephone Number	:	231-436-7400
Fax Number	:	231-436-7446

Provider Business Practice Location Address
First Line	:	230 W CENTRAL
Second Line	:
City	:	MACKINAW CITY
State	:	MI
Zip	:	49701
Country	:	US
Telephone Number	:	231-436-7400
Fax Number	:	231-436-7446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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