Provider Demographics
NPI:1952412801
Name:PRICE, LARRY RANDOLPH (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:RANDOLPH
Last Name:PRICE
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 1:824 E REDD RD STE 1-A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7262
Mailing Address - Country:US
Mailing Address - Phone:915-581-8152
Mailing Address - Fax:915-833-7517
Practice Address - Street 1:824 E REDD RD STE 1-A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7262
Practice Address - Country:US
Practice Address - Phone:915-581-8152
Practice Address - Fax:915-833-7517
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD07326OtherBCBS OF TEXAS
PA768511OtherUCCI