Healthcare Provider Details

I. General information

NPI: 1740573526
Provider Name (Legal Business Name): DR. LARRY D. SCARBOROUGH JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7820 SHRADER RD
RICHMOND VA
23294-4222
US

IV. Provider business mailing address

11167 LIVE OAK CIR
MIDLOTHIAN VA
23113-3101
US

V. Phone/Fax

Practice location:
  • Phone: 804-672-8607
  • Fax: 804-672-8608
Mailing address:
  • Phone: 703-407-7667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401412495
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: