Provider Demographics
NPI:1811056237
Name:SLEPICKA, LARRY JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JAMES
Last Name:SLEPICKA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16691 INNSBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5664
Mailing Address - Country:US
Mailing Address - Phone:952-432-0965
Mailing Address - Fax:952-432-9665
Practice Address - Street 1:1515 SAINT FRANCIS AVE
Practice Address - Street 2:#145
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3387
Practice Address - Country:US
Practice Address - Phone:952-496-1538
Practice Address - Fax:952-496-3910
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND90751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice