Individual
DR. ANDREW MICHAEL LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
310 W LOSEY ST, SCOTT AFB, IL 62225-5250
(618) 256-6667
Mailing address
310 W LOSEY ST, SCOTT AFB, IL 62225-5250
(618) 256-6667
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-4087
ID
Other
Enumeration date
08/16/2007
Last updated
08/16/2007
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