Healthcare Provider Details

I. General information

NPI: 1336148006
Provider Name (Legal Business Name): LARRY ALLEN MCLAUGHLIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 EASTWOOD DR
NORWALK OH
44857-1104
US

IV. Provider business mailing address

79 EASTWOOD DR
NORWALK OH
44857-1104
US

V. Phone/Fax

Practice location:
  • Phone: 419-663-3494
  • Fax:
Mailing address:
  • Phone: 419-663-3494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30015187
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: