Healthcare Provider Details

I. General information

NPI: 1508872284
Provider Name (Legal Business Name): LOUIS MICHAEL CARRATOLA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 E MAIN ST
NEW LONDON OH
44851-1233
US

IV. Provider business mailing address

1704 BERLIN ST
MILAN OH
44846-9521
US

V. Phone/Fax

Practice location:
  • Phone: 419-929-1544
  • Fax: 419-929-0402
Mailing address:
  • Phone: 419-499-2472
  • Fax: 419-499-8126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30017312
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: