Provider Demographics
NPI:1447256516
Name:OESTERLE, LARRY J (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:OESTERLE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11693 E LAKE PL
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5849
Mailing Address - Country:US
Mailing Address - Phone:720-848-2521
Mailing Address - Fax:
Practice Address - Street 1:ORAL HEALTH CENTER
Practice Address - Street 2:13065 EAST 17TH AVE
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010
Practice Address - Country:US
Practice Address - Phone:720-848-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71001223X0400X
TX162171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02071009Medicaid