Individual
DR. CARL LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3909 E FAIRVIEW AVE STE 150, MERIDIAN, ID 83642-5814
(208) 996-5808
Mailing address
3909 E FAIRVIEW AVE STE 150, MERIDIAN, ID 83642-5814
(208) 996-5808
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-4553
ID
Other
Enumeration date
07/15/2010
Last updated
04/22/2021
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