Larry R Ficklin, DDS

Key facts

NPI

1962669283

Entity type

Individual (NPI type 1)

Primary specialty

Dentist 122300000X

License

012855 (MO)

Practice address

104 Miller St
New Haven, MO 63068-1143

Phone

(573) 237-3038

Fax

(573) 237-2987

NPI assigned

May 22, 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

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 22, 2008.

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211414400000",
    "number": "1962669283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 MILLER ST",
            "city": "NEW HAVEN",
            "state": "MO",
            "postal_code": "630681143",
            "telephone_number": "573-237-3038",
            "fax_number": "573-237-2987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MILLER ST",
            "city": "NEW HAVEN",
            "state": "MO",
            "postal_code": "630681143",
            "telephone_number": "573-237-3038",
            "fax_number": "573-237-2987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FICKLIN",
        "first_name": "LARRY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-22",
        "last_updated": "2008-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "012855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, MO

• Mariane Beffa Brueggemann, MS, LPC
• Anna Carey-Tiedtke, CCC-SLP
• Thomas E Davis, M.D.
• Barbara A Eggert, OTR/L
• Francesca Maria Ferrentelli, PH.D., LPC, BCC
• Lindsey Beth Jasper, LCSW
• Shawnda Jones
• Barbara E King, FNP-BC
• Luke Komotos
• Doris Marie Kutz-Compton, D.C.

All providers in New Haven, MO · Dentist in Missouri