Liberty Dental Louis M. Carratola DDS LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30017312 Issued in OH

Legal business name

LIBERTY DENTAL LOUIS M. CARRATOLA DDS LLC

Practice address

2380 Sean Dr
Suite 101
Fremont, OH 43420-9741

Phone

(419) 332-6131

NPI assigned

Feb 21, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Louis M Carratola, DDS

Title

Member

Phone

(419) 499-2472

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386115200000",
    "number": "1922371046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2380 SEAN DR",
            "address_2": "SUITE 101",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434209741",
            "telephone_number": "419-332-6131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2380 SEAN DR",
            "address_2": "SUITE 101",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434209741",
            "telephone_number": "419-332-6131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY DENTAL LOUIS M. CARRATOLA DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-21",
        "last_updated": "2013-12-04",
        "status": "A",
        "authorized_official_last_name": "CARRATOLA",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "419-499-2472",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30017312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0061195",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0525079",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Fremont, OH
• Providers in Fremont, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.