MEDICARE: LARRY E. PRICE DDS PA

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	4938	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871771261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARRY E. PRICE DDS PA

Provider Business Mailing Address
First Line	:	114 MARSHALL ST
Second Line	:	POB 638
City	:	ROSE HILL
State	:	NC
Zip	:	28458-0638
Country	:	US
Telephone Number	:	910-289-2081
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 MARSHALL ST
Second Line	:
City	:	ROSE HILL
State	:	NC
Zip	:	28458-0638
Country	:	US
Telephone Number	:	910-289-2081
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LARRY PRICE
Credential	:
Telephone Number	:	910-289-2081

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	02/07/2008

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