Provider Demographics
NPI:1154542397
Name:LATULIPPE, CHRISTIE JEAN (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:JEAN
Last Name:LATULIPPE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3781 S NOVA RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-4291
Mailing Address - Country:US
Mailing Address - Phone:386-574-8388
Mailing Address - Fax:386-574-0495
Practice Address - Street 1:3781 S NOVA RD
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-4291
Practice Address - Country:US
Practice Address - Phone:386-574-8388
Practice Address - Fax:386-574-0495
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist