Provider Demographics
NPI:1750584603
Name:JUMPER, LARRY C (DDS)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:C
Last Name:JUMPER
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 1:1861 ROBERT WYNN ST
Mailing Address - Street 2:A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936
Mailing Address - Country:US
Mailing Address - Phone:915-591-3331
Mailing Address - Fax:915-590-6412
Practice Address - Street 1:1861 ROBERT WYNN ST
Practice Address - Street 2:A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:915-591-3331
Practice Address - Fax:915-590-6412
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8794122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist