Provider Demographics
NPI:1972728020
Name:ALLEN, LARRY GUY (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:GUY
Last Name:ALLEN
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 1:3231 S COUNTRY CLUB WAY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4053
Mailing Address - Country:US
Mailing Address - Phone:489-831-6333
Mailing Address - Fax:480-831-5190
Practice Address - Street 1:3231 S COUNTRY CLUB WAY
Practice Address - Street 2:SUITE 109
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4053
Practice Address - Country:US
Practice Address - Phone:489-831-6333
Practice Address - Fax:480-831-5190
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice