Larry McBride, DDS
Individual provider Active NPI Dentist · Christopher, IL
NPI 1073608014 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1073608014
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- Practice address
- 4241 Hwy 14 West
Rea Dental Clinic
Christopher, IL 62822 - Phone
- (618) 724-2401
- Fax
- (618) 724-2571
- NPI assigned
- Oct 4, 2006
- 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 |
|---|---|---|---|
| 019012749 | IL | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | IL | Yes |
Addresses
Primary practice location
4241 Hwy 14 West
Rea Dental Clinic
Christopher, IL 62822
Mailing address
PO Box 155
Rea Clinic
Christopher, IL 62822
Phone (618) 724-2401
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1002888 | Medicaid | IL |
Other providers in Christopher, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.