Individual
LYDIA FRANCES LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2203 HOLIDAY DR, JANESVILLE, WI 53545
(608) 752-2931
Mailing address
2203 HOLIDAY DR, JANESVILLE, WI 53545-0317
(608) 752-2931
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1001861
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2018
Last updated
06/12/2018
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