Provider Demographics
NPI:1386645802
Name:BOECKER, LARRY ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ROBERT
Last Name:BOECKER
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 1:3733 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-5249
Mailing Address - Country:US
Mailing Address - Phone:281-980-1811
Mailing Address - Fax:281-980-3321
Practice Address - Street 1:3733 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-5249
Practice Address - Country:US
Practice Address - Phone:281-980-1811
Practice Address - Fax:281-980-3321
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice