Provider Demographics
NPI:1407955446
Name:LARRY A. DYER DDS, P.C.
Entity type:Organization
Organization Name:LARRY A. DYER DDS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-691-5142
Mailing Address - Street 1:11317 S WESTERN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5849
Mailing Address - Country:US
Mailing Address - Phone:405-691-5142
Mailing Address - Fax:405-691-2849
Practice Address - Street 1:11317 S WESTERN
Practice Address - Street 2:STE 400
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-5850
Practice Address - Country:US
Practice Address - Phone:405-691-5142
Practice Address - Fax:405-691-2849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty