Provider Demographics
NPI:1609855030
Name:WEDDLE, LARRY T JR (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:T
Last Name:WEDDLE
Suffix:JR
Gender:M
Credentials:DMD,MS
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Mailing Address - Street 1:1001 W 120TH AVE
Mailing Address - Street 2:STE. 110
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2703
Mailing Address - Country:US
Mailing Address - Phone:303-255-3339
Mailing Address - Fax:303-255-9779
Practice Address - Street 1:1001 W 120TH AVE
Practice Address - Street 2:STE. 110
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2703
Practice Address - Country:US
Practice Address - Phone:303-255-3339
Practice Address - Fax:303-255-9779
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2007-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO80651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics