Provider Demographics
NPI:1326225509
Name:LEEMASTER, LARRY D (DDS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:LEEMASTER
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 1:3001 S TELEPHONE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2942
Mailing Address - Country:US
Mailing Address - Phone:405-793-8300
Mailing Address - Fax:405-793-8397
Practice Address - Street 1:3001 S TELEPHONE RD
Practice Address - Street 2:SUITE A
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2942
Practice Address - Country:US
Practice Address - Phone:405-793-8300
Practice Address - Fax:405-793-8397
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100089760AMedicaid