Provider Demographics
NPI:1053356253
Name:CHABOT, LARRY LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LEE
Last Name:CHABOT
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 1:3201 BRASSFIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9682
Mailing Address - Country:US
Mailing Address - Phone:336-288-0542
Mailing Address - Fax:336-288-3188
Practice Address - Street 1:3201 BRASSFIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9682
Practice Address - Country:US
Practice Address - Phone:336-288-0542
Practice Address - Fax:336-288-3188
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC54351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice