Provider Demographics
NPI:1023128899
Name:BAMESBERGER, LARRY GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:GEORGE
Last Name:BAMESBERGER
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 1:3223 HEAVINLIN RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385
Mailing Address - Country:US
Mailing Address - Phone:219-464-9684
Mailing Address - Fax:219-465-7271
Practice Address - Street 1:3223 HEAVINLIN RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385
Practice Address - Country:US
Practice Address - Phone:219-464-9684
Practice Address - Fax:219-465-7271
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006466122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice