Provider Demographics
NPI:1033157995
Name:WINBERRY, LARRY CLIFFORD (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:CLIFFORD
Last Name:WINBERRY
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:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-0343
Mailing Address - Country:US
Mailing Address - Phone:870-598-2832
Mailing Address - Fax:870-598-9462
Practice Address - Street 1:469 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-1544
Practice Address - Country:US
Practice Address - Phone:870-598-2832
Practice Address - Fax:870-598-9462
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58800OtherBC & BS ID NUMBER