Provider Demographics
NPI:1982717021
Name:TSCHOPP, LARRY LEROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LEROY
Last Name:TSCHOPP
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:PO BOX 706
Mailing Address - Street 2:1705 WOODFIELD DR
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-0706
Mailing Address - Country:US
Mailing Address - Phone:217-356-6656
Mailing Address - Fax:217-356-0991
Practice Address - Street 1:1705 WOODFIELD DR
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9504
Practice Address - Country:US
Practice Address - Phone:217-356-6656
Practice Address - Fax:217-356-0991
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice