Healthcare Provider Details

I. General information

NPI: 1023130127
Provider Name (Legal Business Name): LARRY C. HARGREAVES, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date: 10/18/2019
Reactivation Date: 11/24/2020

III. Provider practice location address

1401 SW 37TH ST
TOPEKA KS
66611-2369
US

IV. Provider business mailing address

1401 SW 37TH STREET
TOPEKA KS
66611-2369
US

V. Phone/Fax

Practice location:
  • Phone: 785-266-3533
  • Fax: 785-266-9227
Mailing address:
  • Phone: 785-783-7550
  • Fax: 785-783-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number4836
License Number StateKS

VIII. Authorized Official

Name: DR. LARRY C. HARGREAVES
Title or Position: DOCTOR
Credential: DDS
Phone: 785-783-7550