Larry Douglas Sheetrum, DDS
Individual provider Active NPI General Practice Dentistry · Augusta, AR
NPI 1003087362 · NPPES record last updated Sep 9, 2008
Key facts
- NPI
- 1003087362
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2307 (AR)
- Practice address
- 623 N 9TH St
Augusta, AR 72006-2129 - Phone
- (870) 347-3300
- Fax
- (870) 347-3492
- NPI assigned
- Mar 14, 2008
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2307 | AR | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2307 | AR | Yes |
Addresses
Primary practice location
623 N 9TH St
Augusta, AR 72006-2129
Mailing address
623 N 9TH St
Augusta, AR 72006-2129
Phone (870) 347-3300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 167415608 | Medicaid | AR |
Other providers in Augusta, AR
- Aretha Poindexter
- Amanda Renee Rigsby
- Rex Russell
- Stephanie Burden Ryan
- Sheila Chanell Shannon
- Chester Lewis Spears
- State of Arkansas
- Steve D. Chason, D.D.S.
- Steven F Collier MD PA
- Therapy Network
All providers in Augusta, AR · General Practice Dentistry in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.