Provider Demographics
NPI:1902965130
Name:STOKES, LARRY ELDON SR (DDS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ELDON
Last Name:STOKES
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83263-1239
Mailing Address - Country:US
Mailing Address - Phone:208-852-2561
Mailing Address - Fax:208-852-3626
Practice Address - Street 1:35 S STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:PRESTON
Practice Address - State:ID
Practice Address - Zip Code:83263-1239
Practice Address - Country:US
Practice Address - Phone:208-852-2561
Practice Address - Fax:208-852-3626
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist