Provider Demographics
NPI:1497736375
Name:DENCKLAU, LARRY S (DO)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:S
Last Name:DENCKLAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10109 HUFFINES DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089
Mailing Address - Country:US
Mailing Address - Phone:972-475-0475
Mailing Address - Fax:
Practice Address - Street 1:6800 SCENIC DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4552
Practice Address - Country:US
Practice Address - Phone:972-412-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-112818207P00000X
TXM2940207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI26486Medicare UPIN