Provider Demographics
NPI:1427003037
Name:CHESLEY, LARRY DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DEAN
Last Name:CHESLEY
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 COULTER
Mailing Address - Street 2:STE J
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106
Mailing Address - Country:US
Mailing Address - Phone:806-358-7066
Mailing Address - Fax:806-356-0455
Practice Address - Street 1:1900 COULTER
Practice Address - Street 2:STE J
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-358-7066
Practice Address - Fax:806-356-0455
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U15334Medicare UPIN