Healthcare Provider Details

I. General information

NPI: 1194977942
Provider Name (Legal Business Name): LAROSILIERE AND ASSOCIATES DENTAL CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 SILVER HILL RD # G
DISTRICT HEIGHTS MD
20747-1168
US

IV. Provider business mailing address

5805 SILVER HILL RD # G
DISTRICT HEIGHTS MD
20747-1168
US

V. Phone/Fax

Practice location:
  • Phone: 301-568-8444
  • Fax:
Mailing address:
  • Phone: 301-568-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK LAROSILIERE
Title or Position: PRESIDENT
Credential: DDS
Phone: 301-568-8444