Provider Demographics
NPI:1417996950
Name:SHIRE, LARRY H (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:H
Last Name:SHIRE
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 1:339 JOSEPH DR
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5637
Mailing Address - Country:US
Mailing Address - Phone:570-709-2026
Mailing Address - Fax:
Practice Address - Street 1:339 JOSEPH DR
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5637
Practice Address - Country:US
Practice Address - Phone:570-709-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018447L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU51066Medicare UPIN