Individual
DR. IVAN M LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
1002 DIAMOND RDG STE 1500, JEFFERSON CITY, MO 65109-7914
(573) 298-4400
Mailing address
1002 DIAMOND RDG STE 1500, JEFFERSON CITY, MO 65109-7914
(573) 298-4400
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2019008323
MO
122300000X
Dentist
D-4797
ID
1223E0200X
Endodontics
Primary
2019008323
MO
Other
Enumeration date
10/24/2016
Last updated
09/28/2022
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