Provider Demographics
NPI:1699004531
Name:SOWDER, LARRY KYLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:KYLE
Last Name:SOWDER
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 1:2944 TAZEWELL PK
Mailing Address - Street 2:STE #2
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918
Mailing Address - Country:US
Mailing Address - Phone:865-689-2175
Mailing Address - Fax:865-689-7340
Practice Address - Street 1:2944 TAZEWELL PK
Practice Address - Street 2:STE #2
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918
Practice Address - Country:US
Practice Address - Phone:865-689-2175
Practice Address - Fax:865-689-7340
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist