Provider Demographics
NPI:1770755118
Name:WILSON, LARKIN MONROE III (DDS)
Entity type:Individual
Prefix:DR
First Name:LARKIN
Middle Name:MONROE
Last Name:WILSON
Suffix:III
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 1:800 MT HOLLY ROAD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730
Mailing Address - Country:US
Mailing Address - Phone:870-862-8090
Mailing Address - Fax:870-862-0403
Practice Address - Street 1:800 MOUNT HOLLY RD
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4542
Practice Address - Country:US
Practice Address - Phone:870-862-8090
Practice Address - Fax:870-862-0403
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2894122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist