Individual
MR. LARRY LEE PEVNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DENTURIST
Contact information
Practice address
619 CEDAR AVE, MARYSVILLE, WA 98270-4532
(360) 659-6300
(360) 691-7881
Mailing address
619 CEDAR AVE, MARYSVILLE, WA 98270-4532
(360) 659-6300
(360) 691-7881
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DN00000045
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336278910
ORGANIZATIONAL NPI NUMBER
WA
Enumeration date
12/04/2008
Last updated
12/04/2008
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