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NPI Code Detail

MEDICARE: LARRY D PRIBYL DDS PC

MEDICARE: LARRY D PRIBYL DDS PC
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 Dentistry14116MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
136641012OTHERMOBLUE CROSS GROUP #

General Provider Information

NPI Number : 1679650295
Entity Type Code : Organization
Provider Name (Legal Business Name) : LARRY D PRIBYL DDS PC
Provider Business Mailing Address
First Line : 4701 LOGAN AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64136-1161
Country : US
Telephone Number : 816-350-1007
Fax Number : 816-350-1975
Provider Business Practice Location Address
First Line : 4701 LOGAN AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64136-1161
Country : US
Telephone Number : 816-350-1007
Fax Number : 816-350-1975
Authorized Official
Title or Position : PRESIDENT
Name : DR. LARRY DEAN PRIBYL
Credential : DDS
Telephone Number : 816-350-1007
Provider Enumeration Date : 11/01/2006
Last Update Date : 08/22/2020

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