Provider Demographics
NPI:1083769921
Name:ERWICH, LARRY (DMD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:ERWICH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3145
Mailing Address - Country:US
Mailing Address - Phone:203-272-7044
Mailing Address - Fax:203-250-9922
Practice Address - Street 1:420 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3145
Practice Address - Country:US
Practice Address - Phone:203-272-7044
Practice Address - Fax:203-250-9922
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5540122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist