Provider Demographics
NPI:1104922434
Name:PIPER, LARRY S I (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:S
Last Name:PIPER
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RENEE
Other - Middle Name:M
Other - Last Name:PIPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:MULLEN
Mailing Address - State:NE
Mailing Address - Zip Code:69152
Mailing Address - Country:US
Mailing Address - Phone:308-546-2495
Mailing Address - Fax:
Practice Address - Street 1:205 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:MULLEN
Practice Address - State:NE
Practice Address - Zip Code:69152
Practice Address - Country:US
Practice Address - Phone:308-546-2495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084331240Medicare ID - Type Unspecified