Provider Demographics
NPI:1366769341
Name:BURNETT, LARRY (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:BURNETT
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 1:1900 FOWLER ST STE C
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4845
Mailing Address - Country:US
Mailing Address - Phone:509-303-9700
Mailing Address - Fax:509-783-1094
Practice Address - Street 1:1900 FOWLER ST STE C
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4845
Practice Address - Country:US
Practice Address - Phone:509-303-9700
Practice Address - Fax:509-783-1094
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000084141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice