Provider Demographics
NPI:1497743082
Name:KALP, LARRY ROY (D M D)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ROY
Last Name:KALP
Suffix:
Gender:M
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-1259
Mailing Address - Country:US
Mailing Address - Phone:814-652-6050
Mailing Address - Fax:814-652-9183
Practice Address - Street 1:109 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-1259
Practice Address - Country:US
Practice Address - Phone:814-652-6050
Practice Address - Fax:814-652-9183
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0169631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice