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NPI Code Detail

MEDICARE: DR. BOBBY LEE LARRY DDS

MEDICARE: DR. BOBBY LEE LARRY DDS
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
11223G0001XGeneral Practice Dentistry5404TN

General Provider Information

NPI Number : 1356330559
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BOBBY LEE LARRY DDS
Provider Business Mailing Address
First Line : 8105 CHASEVIEW CT
Second Line :
City : NASHVILLE
State : TN
Zip : 37221-4140
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2011 CHARLOTTE AVE
Second Line :
City : NASHVILLE
State : TN
Zip : 37203-2017
Country : US
Telephone Number : 615-329-0008
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2005
Last Update Date : 07/08/2007

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