Provider Demographics
NPI:1063684280
Name:DR. BOBBY LARRY
Entity type:Organization
Organization Name:DR. BOBBY LARRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:LARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-329-0008
Mailing Address - Street 1:2011 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2017
Mailing Address - Country:US
Mailing Address - Phone:615-329-0008
Mailing Address - Fax:615-320-0035
Practice Address - Street 1:2011 CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2017
Practice Address - Country:US
Practice Address - Phone:615-329-0008
Practice Address - Fax:615-320-0035
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty