Provider Demographics
NPI:1265840896
Name:DAVIS, LARRY DENNIS SR
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DENNIS
Last Name:DAVIS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 GLENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-5303
Mailing Address - Country:US
Mailing Address - Phone:615-364-4273
Mailing Address - Fax:615-292-9056
Practice Address - Street 1:1030 W GORDON AVE STE A
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-4515
Practice Address - Country:US
Practice Address - Phone:229-352-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86731223G0001X
MS3979-181223G0001X
GADN122431122300000X
TN04552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice