MEDICARE: DR. LARRY ALLEN UFBERG DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	DS031457L	PA

General Provider Information

NPI Number	:	1235245739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY ALLEN UFBERG DMD

Provider Business Mailing Address
First Line	:	444 N YORK RD
Second Line	:
City	:	HATBORO
State	:	PA
Zip	:	19040-2102
Country	:	US
Telephone Number	:	215-674-5383
Fax Number	:	215-672-6352

Provider Business Practice Location Address
First Line	:	444 N YORK RD
Second Line	:
City	:	HATBORO
State	:	PA
Zip	:	19040-2102
Country	:	US
Telephone Number	:	215-674-5383
Fax Number	:	215-672-6352

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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