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General NPI Number Information
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NPI Number | 1033260773
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Entity Type | Individual
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Provider Name | BURTON V LARGURA DDS
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2705 S BERKLEY RD STE 4A
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City | KOKOMO
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State | IN
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Zip | 46902-8007
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Country | US
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Telephone | 765-453-2619
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Fax | 765-453-5076
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Provider Business Mailing Address
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Address Line | 13150 BROOKSHIRE PKWY
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City | CARMEL
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State | IN
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Zip | 46033-4602
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Country | US
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Telephone | 317-385-9906
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 12010166A
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License Number State | IN
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