Larry Woodfin Treadaway, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12249 Issued in TX

Practice address

504 S Clay St
Ennis, TX 75119-4551

Phone

(972) 875-6081

Fax

(972) 875-5043

NPI assigned

Jul 7, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 26, 2016 through Jan 26, 2028

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 W. Treadaway, D.D.S., Inc.

  • General Practice Dentistry
  • Ennis, TX
  • NPI 1225196264
  NPD (past) Authorized official

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

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215388800000",
    "number": "1952564239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 S CLAY ST",
            "city": "ENNIS",
            "state": "TX",
            "postal_code": "751194551",
            "telephone_number": "972-875-6081",
            "fax_number": "972-875-5043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 S CLAY ST",
            "city": "ENNIS",
            "state": "TX",
            "postal_code": "751194551",
            "telephone_number": "972-875-6081",
            "fax_number": "972-875-5043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TREADAWAY",
        "first_name": "LARRY",
        "middle_name": "WOODFIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-07",
        "last_updated": "2008-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "12249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desirea Thompson, CPNP
• Three Angels Message Pharmacy
• Marisela Tobias Zavala
• Melissa Townsend, PTA
• Thomas Tran, M.D.
• Urgent Plus
• Arnico Vail, CPNP-PC
• Andrea Maria Vasquez, DMD
• Ravindranath Reddy Veeram Reddy, DMD
• Harichandra Vennelakanti, M.S, DPT

• General Practice Dentistry in Ennis, TX
• Providers in Ennis, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.