Healthcare Provider Details

I. General information

NPI: 1447553169
Provider Name (Legal Business Name): JEFFREY GRANT LARKIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 COUNTRY CLUB TER
LAWRENCE KS
66049-2450
US

IV. Provider business mailing address

647 COUNTRY CLUB TER
LAWRENCE KS
66049-2450
US

V. Phone/Fax

Practice location:
  • Phone: 785-749-2525
  • Fax:
Mailing address:
  • Phone: 785-749-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60665
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: