Individual
JEFFREY D LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D., P.C.
Contact information
Practice address
1211 S KIMBALL AVE, CALDWELL, ID 83605-4626
(208) 454-2061
(208) 459-6899
Mailing address
1211 S KIMBALL AVE, CALDWELL, ID 83605-4626
(208) 454-2061
(208) 459-6899
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3638
IA
Other
Enumeration date
08/14/2006
Last updated
07/08/2007
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