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General NPI Number Information
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NPI Number | 1649335670
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Entity Type | Individual
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Provider Name | LARRY EDWARD ABBOTT D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 620 TENNESSEE AVE
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City | ETOWAH
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State | TN
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Zip | 37331-1304
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Country | US
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Telephone | 423-263-7315
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Fax | 423-263-5055
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Provider Business Mailing Address
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Address Line | 620 TENNESSEE AVE PO BOX 517
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City | ETOWAH
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State | TN
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Zip | 37331-1304
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Country | US
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Telephone | 423-263-7315
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Fax | 423-263-5055
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DS003274
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License Number State | TN
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