Provider Demographics
NPI:1235245739
Name:UFBERG, LARRY ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ALLEN
Last Name:UFBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:ALLEN
Other - Last Name:UFBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:444 N YORK RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-2102
Mailing Address - Country:US
Mailing Address - Phone:215-674-5383
Mailing Address - Fax:215-672-6352
Practice Address - Street 1:444 N YORK RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-2102
Practice Address - Country:US
Practice Address - Phone:215-674-5383
Practice Address - Fax:215-672-6352
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031457L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics