Individual
DR. LARA INGA LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
96TH DENTAL SQUADRON, 307 BOATNER AVENUE, EGLIN AFB, FL 32542
(850) 883-8052
Mailing address
207 GRACIE LANE, NICEVILLE, FL 32578
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
5846
NE
Other
Enumeration date
09/30/2005
Last updated
08/12/2011
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