Healthcare Provider Details

I. General information

NPI: 1285770834
Provider Name (Legal Business Name): LARRY ALLAN CASKEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7517 BEECHWOOD CENTRE RD STE 100
AVON IN
46123-7879
US

IV. Provider business mailing address

94 S TENNESSEE ST
DANVILLE IN
46122-1836
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-8100
  • Fax:
Mailing address:
  • Phone: 317-745-1400
  • Fax: 317-745-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12009458B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: