Provider Demographics
NPI:1033304472
Name:LARASH, STEPHEN JEROME (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JEROME
Last Name:LARASH
Suffix:
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 1:3512 ASBURY ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1892
Mailing Address - Country:US
Mailing Address - Phone:214-363-3703
Mailing Address - Fax:
Practice Address - Street 1:8215 WESTCHESTER DR
Practice Address - Street 2:SUITE 134
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6103
Practice Address - Country:US
Practice Address - Phone:214-363-3703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice