Provider Demographics
NPI:1295067452
Name:HAWS, LARRY TRAVIS (DDS)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:TRAVIS
Last Name:HAWS
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 1:858 W. HAPPY CANYON RD #135
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108
Mailing Address - Country:US
Mailing Address - Phone:303-688-3800
Mailing Address - Fax:303-688-3999
Practice Address - Street 1:858 W. HAPPY CANYON RD #135
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108
Practice Address - Country:US
Practice Address - Phone:303-688-3800
Practice Address - Fax:303-688-3999
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9813122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1251538Medicaid