Organization
LARRY D PRIBYL DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY DEAN PRIBYL DDS (PRESIDENT)
(816) 350-1007
Entity
Organization
Contact information
Practice address
4701 LOGAN AVE, KANSAS CITY, MO 64136-1161
(816) 350-1007
(816) 350-1975
Mailing address
4701 LOGAN AVE, KANSAS CITY, MO 64136-1161
(816) 350-1007
(816) 350-1975
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14116
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36641012
BLUE CROSS GROUP #
MO
Enumeration date
11/01/2006
Last updated
08/22/2020
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