Organization
VERNON A. LARSEN D.D.S., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VERNON A LARSEN D.D.S. (PRESIDENT)
(920) 722-4293
Entity
Organization
Contact information
Practice address
59 RACINE ST, MENASHA, WI 54952-3133
(920) 722-4293
(920) 722-3394
Mailing address
59 RACINE ST, MENASHA, WI 54952-3133
(920) 722-4293
(920) 722-3394
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4001803
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33600000
—
WI
Enumeration date
07/26/2006
Last updated
08/22/2020
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