Provider Demographics
NPI:1528285970
Name:LAROUE, ERIC STEVEN (DDS)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:STEVEN
Last Name:LAROUE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W HARRIE ST
Mailing Address - Street 2:P.O.BOX 504
Mailing Address - City:NEWBERRY
Mailing Address - State:MI
Mailing Address - Zip Code:49868-1226
Mailing Address - Country:US
Mailing Address - Phone:906-293-8291
Mailing Address - Fax:
Practice Address - Street 1:501 W HARRIE ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:MI
Practice Address - Zip Code:49868-1226
Practice Address - Country:US
Practice Address - Phone:906-293-8291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010157001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901015700OtherSTATE DENTAL LICENSE NUMB