Provider Demographics
NPI:1114140225
Name:LARRY C. HARGREAVES, DDS
Entity Type:Organization
Organization Name:LARRY C. HARGREAVES, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARGREAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-364-8414
Mailing Address - Street 1:314 NEOSHO ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:66839-1926
Mailing Address - Country:US
Mailing Address - Phone:620-364-8414
Mailing Address - Fax:620-364-8416
Practice Address - Street 1:314 NEOSHO ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KS
Practice Address - Zip Code:66839-1926
Practice Address - Country:US
Practice Address - Phone:620-364-8414
Practice Address - Fax:620-364-8416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100096690CMedicaid