Individual
DR. LARRY WILSON ANTHONY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2953 BROAD AVE, MEMPHIS, TN 38112-2957
(901) 271-6050
(901) 271-0699
Mailing address
2595 CENTRAL AVE, MEMPHIS, TN 38104-5905
(901) 260-8551
(901) 260-8590
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN014026
GA
1223G0001X
General Practice Dentistry
Primary
9470
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q001343
—
TN
Enumeration date
02/05/2010
Last updated
09/27/2013
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