Healthcare Provider Details

I. General information

NPI: 1912127598
Provider Name (Legal Business Name): CHRISTOPHER KEVIN LATOCHA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W CENTRAL
MACKINAW CITY MI
49701
US

IV. Provider business mailing address

PO BOX 854
MACKINAW CITY MI
49701-0854
US

V. Phone/Fax

Practice location:
  • Phone: 231-436-7400
  • Fax: 231-436-7446
Mailing address:
  • Phone: 231-436-7400
  • Fax: 231-436-7446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16009
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: