Larry Lee Jack, DDS

Dentist · Leadville, CO

Individual Active NPI

NPI number 1386982247

Practice location

404 E 7TH St
Leadville, CO 80461-3131
Phone
(410) 980-5433

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NPI record

NPI
1386982247
Entity type
Individual (Type 1)
Enumeration date
January 27, 2013
Last updated
January 27, 2013
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Dentist Primary 122300000X 7752 CO
Dentist 122300000X 9327 MD

Mailing address

PO Box 476
Leadville, CO 80461-0476

About Dr. Jack

Larry Lee Jack, DDS is a healthcare provider registered in the NPI registry with the primary taxonomy Dentist (code 122300000X). The practice location is 404 E 7TH St, Leadville, CO 80461-3131. The NPI number 1386982247 was assigned on January 27, 2013 and the record was last updated on January 27, 2013.

Dr. Jack lists 2 licenses in the registry: #7752 (CO) for Dentist; #9327 (MD) for Dentist. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Larry Lee Jack, DDS?

The NPI number is 1386982247.

What is the phone number of Dr. Jack?

The phone number listed for the practice location is (410) 980-5433.

Where is Dr. Jack located?

404 E 7TH St, Leadville, CO 80461-3131.

What is the taxonomy code for Dr. Jack?

The primary taxonomy code is 122300000X – Dentist; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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