Provider Demographics
NPI:1134221492
Name:PRITCHARD, LARRY J (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:PRITCHARD
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 1:7030 NEW SANGER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-4073
Mailing Address - Country:US
Mailing Address - Phone:254-751-1171
Mailing Address - Fax:254-751-0884
Practice Address - Street 1:7030 NEW SANGER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3991
Practice Address - Country:US
Practice Address - Phone:254-751-1171
Practice Address - Fax:254-751-0884
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT153731223S0112X
TX108801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00077SMedicare ID - Type UnspecifiedMEDICARE PROVIDER #