DR. Larry Lee Jack, DDS

NPI #1386982247 in Leadville, Colorado

Provider Information

NPI Number: 1386982247
Entity Type: Individual
Name: DR. Larry Lee Jack, DDS
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist
Credential: DDS
Enumeration Date: Jan 27, 2013
Last Updated: Jan 27, 2013

Practice Location

Address: 404 E 7TH ST
City: Leadville
State: Colorado
ZIP Code: 80461-3131
Phone: (410) 980-5433

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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Organizations

Provider Name	Specialty	City
Leadville Dental Center LLC	Dentist	Leadville	AI Deep Dive

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