Provider Demographics
NPI:1386097343
Name:ROLLE, LATOYA LEGRAND (DDS)
Entity type:Individual
Prefix:DR
First Name:LATOYA
Middle Name:LEGRAND
Last Name:ROLLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12964 NARCOOSSEE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6925
Mailing Address - Country:US
Mailing Address - Phone:407-627-1234
Mailing Address - Fax:
Practice Address - Street 1:12964 NARCOOSSEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6925
Practice Address - Country:US
Practice Address - Phone:407-627-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN263981223P0221X, 1223P0221X
AR41331223G0001X
MS4093-191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice