Healthcare Provider Details

I. General information

NPI: 1144605213
Provider Name (Legal Business Name): NATALIE LA ROCHELLE DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 WILLOW LAWN DR
RICHMOND VA
23226-1409
US

IV. Provider business mailing address

1206 WILLOW LAWN DR
RICHMOND VA
23226-1409
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-0505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number65289
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401415702
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: