Provider Demographics
NPI:1740283381
Name:KREVITZ, LARRY ELLIOT (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ELLIOT
Last Name:KREVITZ
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 1:122 N YORK RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-2617
Mailing Address - Country:US
Mailing Address - Phone:215-674-2505
Mailing Address - Fax:215-674-2953
Practice Address - Street 1:122 N YORK RD
Practice Address - Street 2:SUITE 11
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-2617
Practice Address - Country:US
Practice Address - Phone:215-674-2505
Practice Address - Fax:215-674-2953
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022252L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice