Provider Demographics
NPI:1326117979
Name:ALQUIST, LARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:ALQUIST
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 1:109 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50441-1844
Mailing Address - Country:US
Mailing Address - Phone:641-456-4666
Mailing Address - Fax:641-456-5592
Practice Address - Street 1:109 3RD ST NE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50441-1844
Practice Address - Country:US
Practice Address - Phone:641-456-4666
Practice Address - Fax:641-456-5592
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA057481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice