Provider Demographics
NPI:1598729261
Name:MEADOR, LARRY RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:RICHARD
Last Name:MEADOR
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 1:4437 STARKEY RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-2818
Mailing Address - Country:US
Mailing Address - Phone:540-774-5900
Mailing Address - Fax:540-776-3496
Practice Address - Street 1:4437 STARKEY RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-2819
Practice Address - Country:US
Practice Address - Phone:540-774-5900
Practice Address - Fax:540-776-3496
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005671122300000X
VA04380000521223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00W119V01Medicare PIN
VAT21848Medicare UPIN