Individual
MICHAEL JOE LARSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
30940 STAGECOACH BLVD, STE E250, EVERGREEN, CO 80439-7984
(303) 674-6777
Mailing address
27767 WHIRLAWAY TRL, EVERGREEN, CO 80439-6463
(303) 674-8229
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
H-D-1-04331
CO
Other
Enumeration date
06/27/2005
Last updated
07/08/2007
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