Provider Demographics
NPI:1043311103
Name:PRIBYL, LARRY DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DEAN
Last Name:PRIBYL
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 1:3320 NE RALPH POWELL RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2368
Mailing Address - Country:US
Mailing Address - Phone:816-795-1000
Mailing Address - Fax:816-350-1075
Practice Address - Street 1:4801 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7015
Practice Address - Country:US
Practice Address - Phone:816-795-1000
Practice Address - Fax:816-350-1975
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO141161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11121040OtherBLUE CROSS BLUE SHIELD