Organization
DR ROBERT L LARISON PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT L LARISON D.D.S. (PRESIDENT)
(217) 528-1502
Entity
Organization
Contact information
Practice address
1214 S 4TH ST, SPRINGFIELD, IL 62703-2229
(217) 528-1502
(217) 528-7448
Mailing address
1214 S 4TH ST, SPRINGFIELD, IL 62703-2229
(217) 528-1502
(217) 528-7448
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002641
—
IL
Enumeration date
04/19/2007
Last updated
08/22/2020
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