Provider Demographics
NPI:1285834531
Name:WYNNE, LARRY EMANUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:EMANUEL
Last Name:WYNNE
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 1:900 71ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-2916
Mailing Address - Country:US
Mailing Address - Phone:305-865-0336
Mailing Address - Fax:305-861-2300
Practice Address - Street 1:900 71ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-2916
Practice Address - Country:US
Practice Address - Phone:305-865-0336
Practice Address - Fax:305-861-2300
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2363122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist