Individual
LARRY D DORMOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S, M.S.
Contact information
Practice address
875 UNION AVE, MEMPHIS, TN 38103
(901) 448-6240
Mailing address
7118 BELL MANOR CV, GERMANTOWN, TN 38138-1900
(901) 758-8066
(901) 448-6249
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
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