Provider Demographics
NPI:1548338759
Name:OUBRE, LARRY M JR (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:M
Last Name:OUBRE
Suffix:JR
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 1:942 ONEAL LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-1807
Mailing Address - Country:US
Mailing Address - Phone:225-272-0828
Mailing Address - Fax:225-273-1862
Practice Address - Street 1:942 ONEAL LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-1807
Practice Address - Country:US
Practice Address - Phone:225-272-0828
Practice Address - Fax:225-273-1862
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA2856122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU35398Medicare UPIN