Provider Demographics
NPI:1043645963
Name:LARREAU AND THOMAS, PLLC
Entity type:Organization
Organization Name:LARREAU AND THOMAS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARREAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-617-5888
Mailing Address - Street 1:17317 27TH AVE NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-4745
Mailing Address - Country:US
Mailing Address - Phone:360-653-5577
Mailing Address - Fax:
Practice Address - Street 1:17317 27TH AVE NE
Practice Address - Street 2:SUITE 101
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4745
Practice Address - Country:US
Practice Address - Phone:360-653-5577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60074615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty