Individual
DR. MICHAEL THOMAS FAVALORO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D D S
Contact information
Practice address
2024 WEST MAIN STREET, LUTCHER, LA 70071
(225) 869-8281
(225) 869-8868
Mailing address
3500 REDWOOD LN, PAULINA, LA 70763-2320
(225) 869-4811
(225) 869-8868
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5718
LA
Other
Enumeration date
09/26/2006
Last updated
07/08/2007
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