Provider Demographics
NPI:1568652493
Name:SCHWARTZ, LARRY JACOB (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JACOB
Last Name:SCHWARTZ
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 1:5717 N ARGONNE RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-9663
Mailing Address - Country:US
Mailing Address - Phone:509-534-4600
Mailing Address - Fax:509-533-6334
Practice Address - Street 1:104 S FREYA ST STE 127
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4881
Practice Address - Country:US
Practice Address - Phone:509-534-4600
Practice Address - Fax:509-533-6334
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL05111091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE00003068OtherWA DEPARTMENT OF HEALTH
WAL0511109OtherBUSINESS LICENSE