Provider Demographics
NPI:1538104807
Name:CAUSEY, LARRY GRADY (DDS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:GRADY
Last Name:CAUSEY
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 1:204 S MARSHALL ST
Mailing Address - Street 2:P.O. BOX 764
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3322
Mailing Address - Country:US
Mailing Address - Phone:336-227-1187
Mailing Address - Fax:336-506-1004
Practice Address - Street 1:204 S MARSHALL ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3322
Practice Address - Country:US
Practice Address - Phone:336-227-1187
Practice Address - Fax:336-506-1004
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC44711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8991473Medicaid