Provider Demographics
NPI:1518260603
Name:TEMPLIN, LARRY S (DDS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:S
Last Name:TEMPLIN
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 1:1316 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5922
Mailing Address - Country:US
Mailing Address - Phone:916-448-7438
Mailing Address - Fax:916-448-0918
Practice Address - Street 1:1316 26TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5922
Practice Address - Country:US
Practice Address - Phone:916-448-7438
Practice Address - Fax:916-448-0918
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice