Healthcare Provider Details

I. General information

NPI: 1174651889
Provider Name (Legal Business Name): DR. THOMAS MOSES LATOUCHE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: THOMAS LATOUCHE DDS

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W SPOTSWOOD AVE
ELKTON VA
22827-1119
US

IV. Provider business mailing address

116 W SPOTSWOOD AVE
ELKTON VA
22827-1119
US

V. Phone/Fax

Practice location:
  • Phone: 540-298-9419
  • Fax:
Mailing address:
  • Phone: 540-298-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401005456
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: