Provider Demographics
NPI:1316045834
Name:LARRY E. MCENTIRE, D.D.S., P. C.
Entity Type:Organization
Organization Name:LARRY E. MCENTIRE, D.D.S., P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCENTIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-669-2573
Mailing Address - Street 1:8813 BUFFALO CLOUD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89143-5407
Mailing Address - Country:US
Mailing Address - Phone:702-655-2882
Mailing Address - Fax:702-655-7980
Practice Address - Street 1:1220 W ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5647
Practice Address - Country:US
Practice Address - Phone:928-669-2573
Practice Address - Fax:928-669-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty