Provider Demographics
NPI:1801996749
Name:BURT, LARRY DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DAVID
Last Name:BURT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190
Mailing Address - Country:US
Mailing Address - Phone:781-331-3030
Mailing Address - Fax:781-335-5878
Practice Address - Street 1:696 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190
Practice Address - Country:US
Practice Address - Phone:781-331-3030
Practice Address - Fax:781-335-5878
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA162571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice