Provider Demographics
NPI:1659775054
Name:LARRY DEGROAT,D.D.S.,P.C.
Entity Type:Organization
Organization Name:LARRY DEGROAT,D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGROAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-644-1216
Mailing Address - Street 1:32100 TELEGRAPH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2408
Mailing Address - Country:US
Mailing Address - Phone:248-644-1216
Mailing Address - Fax:248-644-1568
Practice Address - Street 1:32100 TELEGRAPH RD STE 102
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-2408
Practice Address - Country:US
Practice Address - Phone:248-644-1216
Practice Address - Fax:248-644-1568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114947835OtherDENTIST