Organization
KEITH R LARSON DMD PC
Active
Other names
Apnea and Snoring
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH RODNEY LARSON DMD, PC (OWNER)
(503) 292-0416
Entity
Organization
Contact information
Practice address
17895 NW EVERGREEN PKWY, 130, BEAVERTON, OR 97006-7402
(503) 716-6712
(503) 536-6617
Mailing address
17895 NW EVERGREEN PKWY, 130, BEAVERTON, OR 97006-7402
(503) 716-6712
(503) 536-6617
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
D4338
OR
Other
Enumeration date
10/01/2015
Last updated
10/20/2017
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