Provider Demographics
NPI:1174632236
Name:MCGARY, LARRY TATE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:TATE
Last Name:MCGARY
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:PO BOX 1085
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-1085
Mailing Address - Country:US
Mailing Address - Phone:785-238-3500
Mailing Address - Fax:
Practice Address - Street 1:903 W 6TH ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-3228
Practice Address - Country:US
Practice Address - Phone:785-238-3500
Practice Address - Fax:785-238-8323
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS60311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS421736OtherBLUE CROSS BLUE SHIELD
KS733311OtherUNITED CONCORDIA TRICARE