Individual
DR. DOUGLAS MARSHALL LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
680 FAIRMOUNT AVE, JAMESTOWN, NY 14701-2630
(716) 483-1718
(716) 661-9623
Mailing address
680 FAIRMOUNT AVE, JAMESTOWN, NY 14701-2630
(716) 483-1718
(716) 661-9623
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
049 677
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
049 677
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02740834
—
NY
Enumeration date
10/25/2005
Last updated
05/12/2014
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