Healthcare Provider Details

I. General information

NPI: 1285039065
Provider Name (Legal Business Name): MARIE LATORTUE DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 GASTON AVE
DALLAS TX
75246-2013
US

IV. Provider business mailing address

3302 GASTON AVE
DALLAS TX
75246-2013
US

V. Phone/Fax

Practice location:
  • Phone: 214-828-8350
  • Fax: 214-874-4555
Mailing address:
  • Phone: 214-828-8350
  • Fax: 214-874-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30526
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: