MEDICARE: DR. LARRY J ANTHONY D.D.S.

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	1223G0001X	General Practice Dentistry	012676	MO

General Provider Information

NPI Number	:	1639154800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY J ANTHONY D.D.S.

Provider Business Mailing Address
First Line	:	1002 N MAIN ST
Second Line	:
City	:	SIKESTON
State	:	MO
Zip	:	63801-5044
Country	:	US
Telephone Number	:	573-472-3383
Fax Number	:	573-472-3346

Provider Business Practice Location Address
First Line	:	1002 N MAIN ST
Second Line	:
City	:	SIKESTON
State	:	MO
Zip	:	63801-5044
Country	:	US
Telephone Number	:	573-472-3383
Fax Number	:	573-472-3346

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

Provider Enumeration Date	:	12/10/2005
Last Update Date	:	07/08/2007

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