Provider Demographics
NPI:1972721272
Name:STRAWN, LARRY J JR (DDS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:J
Last Name:STRAWN
Suffix:JR
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 1:8475 SO VAN NESS AVE
Mailing Address - Street 2:#106
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305
Mailing Address - Country:US
Mailing Address - Phone:323-750-4115
Mailing Address - Fax:323-750-4857
Practice Address - Street 1:8475 SO VAN NESS AVE
Practice Address - Street 2:#106
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305
Practice Address - Country:US
Practice Address - Phone:323-750-4115
Practice Address - Fax:323-750-4857
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD37028OtherDENTICAL
CAG9100001Medicare ID - Type Unspecified
512126Medicare UPIN