LARRY D DORMOIS (NPI# 1386700839) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386700839 |
| Entity Type | Individual |
| Full Name | LARRY D DORMOIS |
| Credential | D.D.S, M.S. |
| Practice Address |
875 Union Ave Memphis TN 38103 |
| Mailing Address |
7118 Bell Manor Cv Germantown TN 38138-1900 |
| Practice Telephone | 9014486240 |
| Mailing Telephone | 9017588066 |
| Mailing Fax Number | 9014486249 |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2019-08-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
3545 | TN | Dental Providers |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
2335 | MS | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 6049 | 05 | |
| AR | 109831608 | 05 | |
| TN | BCBS TN PROVIDER | 4031775 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 848 Adams Ave, Memphis, TN 381032816 | 9014485437 | 9014485438 |
| 875 Union Ave, Memphis, TN 38103 | 9014486240 |
| Street Address |
875 UNION AVE |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366430647 | Lawrence W Weeda Jr. | Dentist | 875 Union Ave, Room N-328, Memphis, TN 38163-0001 | 2005-10-11 |
| 1750907200 | Meghan Gahm | Student in an Organized Health Care Education/Training Program | 875 Union Ave, Memphis, TN 38103-3513 | 2020-06-21 |
| 1134768617 | Deborah Kay Rose | Dental Hygienist | 875 Union Ave, Memphis, TN 38103-3513 | 2019-12-31 |
| 1982249769 | Leila Marie Sears | Dentist | 875 Union Ave, Memphis, TN 38103-3513 | 2019-11-15 |
| 1124680632 | Anna Claire Eaton | Dentist | 875 Union Ave, Memphis, TN 38103-3513 | 2019-07-03 |
| 1164080867 | Bryce James Lamer | Dentist | 875 Union Ave, Memphis, TN 38103-3513 | 2019-05-29 |
| 1699240879 | Brian Ashford Brodine | Dentist | 875 Union Ave, Memphis, TN 38103-3513 | 2018-10-03 |
| 1609351832 | Jared Moffett | Dentist | 875 Union Ave, Memphis, TN 38103-3513 | 2018-10-03 |
| 1437648045 | Jill Emily Gibson | Student in an Organized Health Care Education/Training Program | 875 Union Ave, Memphis, TN 38103-3513 | 2018-05-09 |
| 1093244972 | David Rua Perez | Student in an Organized Health Care Education/Training Program | 875 Union Ave, Memphis, TN 38103-3513 | 2017-06-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619505724 | Michelle Lynn Esposito | Dietitian, Registered | 1st Floor Research Center - 50 North Dunlap St, Memphis, TN 38103 | 2020-04-01 |
| 1962030221 | Allison Burge Clayton | Dietitian, Registered | 50 N Dunlap, Nutrition Therapy Dept, 1st Floor Research Tower, Memphis, TN 38103 | 2020-03-31 |
| 1093375420 | Radar Ems, LLC | Social Worker | 50 S. B.b. King Blvd, Suite 350, Memphis, TN 38103 | 2019-06-18 |
| 1528529021 | Denise Andrews Matthews | Nursing Care | 342 Island Dr #105, Memphis, TN 38103 | 2019-03-27 |
| 1881160059 | Christopher Paul Hernandez | Nurse Practitioner | 877 Jeffeon Ave, Memphis, TN 38103 | 2018-10-15 |
| 1194245712 | Cameron Waters Clinard | Optometrist | 127 Isle Creek Dr, Memphis, TN 38103 | 2017-06-24 |
| 1750732582 | Amanda Leigh Eaves | Nurse Practitioner | 364 S Front St Ste 201, Memphis, TN 38103 | 2016-06-22 |
| 1417304569 | John Clark Shell | Family Medicine | 150 Harbor Creek Dr, Memphis, TN 38103 | 2016-05-18 |
| 1750753695 | Tomisha V. Byard | Nurse Practitioner | 718 Habor Bend Road, Memphis, TN 38103 | 2015-10-29 |
| 1053795179 | Melissa Anne Wilkes | Social Worker | 1240 Harbor River Drive, Memphis, TN 38103 | 2015-07-18 |
| Find all providers in zip 38103 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356775134 | Michael D. Blen Dds PC | Dentist | 6363 Poplar Ave Ste 110, Memphis, TN 38119-4802 | 2013-08-28 |
| 1770880064 | Miller Dental Health | Dentist | 5124 Stage Rd Ste C-2, Memphis, TN 38134-3164 | 2011-02-22 |
| 1710191812 | Ashley Suzanne Ramsey | Dentist | Ut College of Medicine 920 Madison Ave, Suite C50, Memphis, TN 38163-0001 | 2007-05-09 |
| 1538382502 | Courtney Lillianne Wilson | Dentist | 3285 Hacks Cross Rd, Ste 101, Memphis, TN 38125-8918 | 2007-04-10 |
| 1023147790 | Bradley W Wilkinson | Dentist | 5040 Sanderlin Avenue, Suite 101, Memphis, TN 38117 | 2007-03-05 |
| 1790858272 | Harry K. Sharp | Dentist | 875 Union Ave Rm S219, Memphis, TN 38163-0001 | 2006-11-15 |
| 1922197250 | Daniel Derrick Freeman | Dentist | 2567 Appling Rd, Memphis, TN 38133-5099 | 2006-10-12 |
| 1962597971 | Gregory Todd Wilkinson | Dentist | 5610 Murray Rd, Memphis, TN 38119 | 2006-10-04 |
| 1174511604 | Michael D. Blen | Dentist | 6363 Poplar Ave, Suite 110, Memphis, TN 38119-4831 | 2005-10-10 |
| 1760482046 | Sheldon Maurice Graves | Dentist | 4137 Kirby Pkwy, Suite 4, Memphis, TN 38115-6532 | 2005-07-28 |
| Find all providers in MEMPHIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.