Provider Demographics
NPI:1497853097
Name:MCENTIRE, LARRY E (DDS)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:E
Last Name:MCENTIRE
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 1:8813 BUFFALO CLOUD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89143-5407
Mailing Address - Country:US
Mailing Address - Phone:702-655-2882
Mailing Address - Fax:702-655-7980
Practice Address - Street 1:1220 W ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5647
Practice Address - Country:US
Practice Address - Phone:928-669-2573
Practice Address - Fax:928-669-5953
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD20981223G0001X
UT136677-99211223G0001X
NV5006T1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice