Provider Demographics
NPI:1699822452
Name:SANGRIK, LARRY JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JOHN
Last Name:SANGRIK
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 1:401 SOUTH ST STE 3B-1
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-2818
Mailing Address - Country:US
Mailing Address - Phone:440-286-7138
Mailing Address - Fax:440-286-7139
Practice Address - Street 1:401 SOUTH ST STE 3B-1
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-2818
Practice Address - Country:US
Practice Address - Phone:440-286-7138
Practice Address - Fax:440-286-7139
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0162461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice