Provider Demographics
NPI:1700859832
Name:GURLEY, LARRY SHAWN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:SHAWN
Last Name:GURLEY
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 1:4165 OLD MILTON PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4468
Mailing Address - Country:US
Mailing Address - Phone:770-664-1244
Mailing Address - Fax:770-664-1427
Practice Address - Street 1:4165 OLD MILTON PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4468
Practice Address - Country:US
Practice Address - Phone:770-664-1244
Practice Address - Fax:770-664-1427
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice