Provider Demographics
NPI:1750332045
Name:LARRY D. LEEMASTER D.D.S., P.C.
Entity Type:Organization
Organization Name:LARRY D. LEEMASTER D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEEMASTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-793-8300
Mailing Address - Street 1:520 S TELEPHONE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5423
Mailing Address - Country:US
Mailing Address - Phone:405-793-8300
Mailing Address - Fax:405-793-8397
Practice Address - Street 1:520 S TELEPHONE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5423
Practice Address - Country:US
Practice Address - Phone:405-793-8300
Practice Address - Fax:405-793-8397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty