Individual
DR. BRAD A LARREAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
22D MEDICAL GROUP/SGQ, 57950 LEAVENWORTH ST, MCCONNELL AFB, KS 67221-3506
(316) 759-5181
Mailing address
2218 BRYANT ST, DERBY, KS 67037
(316) 789-8926
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
60461
KS
Other
Enumeration date
11/10/2005
Last updated
12/11/2007
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