Provider Demographics
NPI:1104011725
Name:RADNEY, LARRY JOHN (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JOHN
Last Name:RADNEY
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17201 GLENMOUNT PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4300
Mailing Address - Country:US
Mailing Address - Phone:281-486-5081
Mailing Address - Fax:281-486-6507
Practice Address - Street 1:17201 GLENMOUNT PARK DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4300
Practice Address - Country:US
Practice Address - Phone:281-486-5081
Practice Address - Fax:281-486-6507
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics