Provider Demographics
NPI:1992762249
Name:LARRIMORE, MICHAEL FRANCIS (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:LARRIMORE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 C AVE
Mailing Address - Street 2:US ARMY DENTAL CLINIC COMMAND
Mailing Address - City:FORT LEE
Mailing Address - State:VA
Mailing Address - Zip Code:23801-1717
Mailing Address - Country:US
Mailing Address - Phone:804-221-1893
Mailing Address - Fax:804-734-9429
Practice Address - Street 1:2601 C AVE
Practice Address - Street 2:US ARMY DENTAL CLINIC COMMAND
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801-1717
Practice Address - Country:US
Practice Address - Phone:804-221-1893
Practice Address - Fax:804-734-9429
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI 01872000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist