Provider Demographics
NPI:1568570141
Name:SEWARD, LARRY ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ALLEN
Last Name:SEWARD
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 1:72 CANAL ST W
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:OH
Mailing Address - Zip Code:44662-1160
Mailing Address - Country:US
Mailing Address - Phone:330-879-5313
Mailing Address - Fax:330-879-5594
Practice Address - Street 1:72 CANAL ST W
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:OH
Practice Address - Zip Code:44662-1160
Practice Address - Country:US
Practice Address - Phone:330-879-5313
Practice Address - Fax:330-879-5594
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH139781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice