Provider Demographics
NPI:1497767586
Name:SMITH, LARRY EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:EDWARD
Last Name:SMITH
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 1:11275 E MISSISSIPPI AVE
Mailing Address - Street 2:STE 1 - SOUTH - 4
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2820
Mailing Address - Country:US
Mailing Address - Phone:303-361-6668
Mailing Address - Fax:
Practice Address - Street 1:11275 E MISSISSIPPI AVE
Practice Address - Street 2:STE 1 - SOUTH - 4
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2820
Practice Address - Country:US
Practice Address - Phone:520-383-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COH-D-1-05871122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist