Individual
DR. LARRY LEE NILLISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
409A MAIN ST, BIRNAMWOOD, WI 54414-0206
(715) 449-3345
(715) 449-3272
Mailing address
PO BOX 206, 409A MAIN ST, BIRNAMWOOD, WI 54414-0206
(715) 449-3345
(715) 449-3272
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
WI2723
WI
Other
Enumeration date
07/11/2008
Last updated
07/11/2008
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