Larry Edward Van Dyck, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

3939 Issued in AR

Practice address

460 S Holly St
Siloam Springs, AR 72761-3018

Phone

(479) 524-0333

Fax

(479) 524-0378

NPI assigned

Sep 29, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Larry Vandyck DDS Holly Street Dentistry,PA

  • Dentist
  • Siloam Springs, AR
  • NPI 1083043905
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383091200000",
    "number": "1932291382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 S HOLLY ST",
            "address_2": "PO BOX 40",
            "city": "SILOAM SPRINGS",
            "state": "AR",
            "postal_code": "727613018",
            "telephone_number": "479-524-0333",
            "fax_number": "479-524-0378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 S HOLLY ST",
            "city": "SILOAM SPRINGS",
            "state": "AR",
            "postal_code": "727613018",
            "telephone_number": "479-524-0333",
            "fax_number": "479-524-0378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DYCK",
        "first_name": "LARRY",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2013-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "3939",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OK",
            "license": "5246",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Siloam Springs, AR
• Providers in Siloam Springs, AR by specialty
• Dentist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.