Healthcare Provider Details

I. General information

NPI: 1326001447
Provider Name (Legal Business Name): LARRY J DASHOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S BENNETT ST
BURGAW NC
28425-5048
US

IV. Provider business mailing address

PO BOX 219
BURGAW NC
28425-0219
US

V. Phone/Fax

Practice location:
  • Phone: 910-259-8001
  • Fax: 910-259-8003
Mailing address:
  • Phone: 910-259-8001
  • Fax: 910-259-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: