Individual
DR. KEVIN T LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
9370 SW GREENBURG RD GRANT NORTH, SUITE D, PORTLAND, OR 97223
(503) 245-6441
Mailing address
31108 SW PAULINA CT, WILSONVILLE, OR 97070-8529
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8521
OR
Other
Enumeration date
03/27/2007
Last updated
07/08/2007
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