Provider Demographics
NPI:1225196264
Name:LARRY W. TREADAWAY, D.D.S., INC.
Entity type:Organization
Organization Name:LARRY W. TREADAWAY, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:TREADAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-875-6081
Mailing Address - Street 1:504 S CLAY ST
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-4551
Mailing Address - Country:US
Mailing Address - Phone:972-875-6081
Mailing Address - Fax:972-875-5043
Practice Address - Street 1:504 S CLAY ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4551
Practice Address - Country:US
Practice Address - Phone:972-875-6081
Practice Address - Fax:972-875-5043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty