Provider Demographics
NPI:1457448359
Name:BROWDER, LARRY FULTON (DMD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:FULTON
Last Name:BROWDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109
Mailing Address - Country:US
Mailing Address - Phone:334-272-2906
Mailing Address - Fax:334-277-7278
Practice Address - Street 1:4421 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109
Practice Address - Country:US
Practice Address - Phone:334-272-2906
Practice Address - Fax:334-277-7278
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice