Provider Demographics
NPI:1558321455
Name:OVER, LARRY MICHAEL (DMD,MSD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:MICHAEL
Last Name:OVER
Suffix:
Gender:M
Credentials:DMD,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-4501
Mailing Address - Country:US
Mailing Address - Phone:541-687-7860
Mailing Address - Fax:541-338-0255
Practice Address - Street 1:911 COUNTRY CLUB RD.
Practice Address - Street 2:STE 240
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-687-1499
Practice Address - Fax:541-338-0255
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62941223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000NGDNFMedicare ID - Type UnspecifiedMEDICARE
ORU38578Medicare UPIN