Provider Demographics
NPI:1437225232
Name:GARTMAN, LARRY ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ALLEN
Last Name:GARTMAN
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 1:203 N. 24TH ST.
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756
Mailing Address - Country:US
Mailing Address - Phone:479-621-0226
Mailing Address - Fax:479-621-5334
Practice Address - Street 1:203 NORTH 24TH STREET
Practice Address - Street 2:SUITE D
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756
Practice Address - Country:US
Practice Address - Phone:479-621-0226
Practice Address - Fax:479-621-5334
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30011223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics