Healthcare Provider Details

I. General information

NPI: 1760680326
Provider Name (Legal Business Name): CARRATOLA & MERRILL, DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 11/20/2007
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

63 E MAIN ST
NEW LONDON OH
44851-1233
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LOUIS MICHAEL CARRATOLA
Title or Position: MANAGING MEMBER-DENTIST
Credential: D.D.S.
Phone: 419-929-1544