Provider Demographics
NPI:1750815437
Name:DENSON, LARRY JR (RCS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:DENSON
Suffix:JR
Gender:M
Credentials:RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10112 IRON MILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3934
Mailing Address - Country:US
Mailing Address - Phone:804-475-1735
Mailing Address - Fax:
Practice Address - Street 1:909 HIOAKS RD
Practice Address - Street 2:SUITE# D
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4038
Practice Address - Country:US
Practice Address - Phone:804-292-0968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00026046247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other