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DR. LARRY LEE JACK DDS
NPI 1386982247
Dentist in Leadville, CO

Active since January 27, 2013PECOS Enrolled
404 E 7TH ST, LEADVILLE, CO 80461(410) 980-5433 Get Directions Write a Review

NPPES record last updated: January 27, 2013. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Dr. Larry Lee Jack Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. LARRY LEE JACK DDS (NPI 1386982247) is an individual dentist in Leadville, Colorado, licensed in Colorado (7752) and active in the NPI registry since January 2013. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1386982247
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameDR. LARRY LEE JACKCredential: DDS
Location Address404 E 7TH STLeadville, CO 80461-3131
Mailing AddressPo Box 476Leadville, CO 80461-0476
Phone(410) 980-5433
Sole ProprietorYes
Enumeration DateJanuary 27, 2013
✔ NPI 1386982247 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
Licenses✔ Licensed in CO · 7752✔ Licensed in MD · 9327
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
404 E 7TH ST, Leadville, CO 80461
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Larry Lee Jack Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 80461 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$89.43 typical visit price
range $58.06 – $174.82
Typical copayment $22.35 (range $14.51 – $43.70)
Most-billed visit code 99203
Established Patient
$72.20 typical visit price
range $18.88 – $142.79
Typical copayment $18.05 (range $4.72 – $35.69)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Larry Jack's NPI number?

The NPI number for Larry Jack is 1386982247. It was assigned to this individual provider in the NPPES registry on January 27, 2013.

Where is Larry Jack located?

Larry Jack practices at 404 E 7th St, Leadville, CO 80461. The listed phone number is (410) 980-5433.

What is Larry Jack's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Larry Jack enrolled in Medicare?

Yes. Larry Jack is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Larry Jack was last updated on January 27, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.