Provider Demographics
NPI:1083767008
Name:THIGPEN, LARRY VERDELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:VERDELL
Last Name:THIGPEN
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 1:3041 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2460
Mailing Address - Country:US
Mailing Address - Phone:478-750-0003
Mailing Address - Fax:478-750-0015
Practice Address - Street 1:3041 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2460
Practice Address - Country:US
Practice Address - Phone:478-750-0003
Practice Address - Fax:478-750-0015
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA98531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice