Provider Demographics
NPI:1134472426
Name:LARO, JEFFREY J (DMD, MHS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:LARO
Suffix:
Gender:M
Credentials:DMD, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 CHARLIE HALL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-8200
Mailing Address - Country:US
Mailing Address - Phone:843-766-7131
Mailing Address - Fax:843-766-1839
Practice Address - Street 1:2090 CHARLIE HALL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-8200
Practice Address - Country:US
Practice Address - Phone:843-766-7131
Practice Address - Fax:843-766-1839
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31711223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics