Individual
LARRY D DORMOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S, M.S.
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
2335
MS
1223P0221X
Pediatric Dentistry
Primary
3545
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109831608
—
AR
01
—
4031775
BCBS TN PROVIDER
TN
05
—
6049
—
TN
Enumeration date
12/29/2006
Last updated
08/27/2019
Update your record
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