Latortue Smiles
Organization Active NPI General Practice Dentistry · Indian Head, MD
NPI 1124782990 · NPPES record last updated Dec 9, 2021
Key facts
- NPI
- 1124782990
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Legal business name
- LATORTUE SMILES
- Practice address
- 5 N First St
Indian Head, MD 20640-1801 - Phone
- (813) 508-4563
- NPI assigned
- Oct 27, 2021
- Organization subpart
- No
Authorized official
- Name
- Dr. Michelle Latortue, DDS
- Title
- Owner
- Phone
- (813) 508-4563
Practitioners 1
-
Michelle Latortue, DDS
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220111000901 | MD | Part B Supplier - Clinic/Group Practice | 9032501622 |
Receives reassigned benefits from 1 practitioner Practice locations: Indian Head, MD |
National Provider Directory
Locations
5 N First St
Indian Head, MD 20640
Phone (813) 508-4563
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | Yes |
Addresses
Primary practice location
5 N First St
Indian Head, MD 20640-1801
Mailing address
3624 Brothers PL SE
Washington, DC 20032-1523
Phone (813) 508-4563
Other providers in Indian Head, MD
- Carllisa Roshea Jordan
- Memuna Kamara
- Grace W Kariuki
- Kevin F Kelley Sr.
- Keyana Kelly
- Michelle Latortue
- Alan I Lemberg
- Holly N Leymeister
- Tyra Mason
- Keith Lynn Mayberry
All providers in Indian Head, MD · General Practice Dentistry in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.