Provider Demographics
NPI:1316016652
Name:KALKWARF, LARRY STANLEY (DDS)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:STANLEY
Last Name:KALKWARF
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 1:416 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50579-1419
Mailing Address - Country:US
Mailing Address - Phone:712-297-7990
Mailing Address - Fax:
Practice Address - Street 1:416 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROCKWELL CITY
Practice Address - State:IA
Practice Address - Zip Code:50579-1419
Practice Address - Country:US
Practice Address - Phone:712-297-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05071151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0071159Medicaid