Individual
DR. LARRY R FICKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
104 MILLER ST, NEW HAVEN, MO 63068-1143
(573) 237-3038
(573) 237-2987
Mailing address
104 MILLER ST, NEW HAVEN, MO 63068-1143
(573) 237-3038
(573) 237-2987
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
012855
MO
Other
Enumeration date
05/22/2008
Last updated
05/22/2008
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