Provider Demographics
NPI:1033288493
Name:BARGREN, LARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:BARGREN
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 1:6191 E FLAT IRON LOOP
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85218-1877
Mailing Address - Country:US
Mailing Address - Phone:480-474-8052
Mailing Address - Fax:
Practice Address - Street 1:1830 S ALMA SCHOOL RD STE 110
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3086
Practice Address - Country:US
Practice Address - Phone:480-834-1317
Practice Address - Fax:480-649-6148
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD6421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist