Healthcare Provider Details

I. General information

NPI: 1578962866
Provider Name (Legal Business Name): LARRY ZHANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2014
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7223 MISSISSIPPI AVENUE
FORT POLK LA
71459
US

IV. Provider business mailing address

7223 MISSISSIPPI AVE
FORT POLK LA
71459
US

V. Phone/Fax

Practice location:
  • Phone: 726-780-1103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30409
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: