| Organization Name: | LARRY E.BAUCOM, D.D.S., P.A. |
| NPI Number: | 1083732747 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LARRY E. BAUCOM (OWNER) |
| Mailing Address: | 305 Page Rd. Suite 2 Pinehurst |
| State: | NC US |
| Postal Code: | 28374 |
| Phone Number: | 9102951010 |
| Fax Number: | 9102951367 |
| NPI Enumeration Date: | 03/27/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 3258 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |