Provider Demographics
NPI:1609913144
Name:ABELL, LARRY JOE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JOE
Last Name:ABELL
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 1:208 BARNABY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:INCHELIUM
Mailing Address - State:WA
Mailing Address - Zip Code:99138-9565
Mailing Address - Country:US
Mailing Address - Phone:509-738-6245
Mailing Address - Fax:
Practice Address - Street 1:208 BARNABY CREEK RD
Practice Address - Street 2:
Practice Address - City:INCHELIUM
Practice Address - State:WA
Practice Address - Zip Code:99138-9565
Practice Address - Country:US
Practice Address - Phone:509-738-6245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000034371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice