Organization
SAINT ANTHONY VILLAGE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CORY JOHN LARSON DDS (DENTIST)
(612) 789-2853
Entity
Organization
Contact information
Practice address
2525 33RD AVE NE, ST ANTHONY, MN 55418-1539
(612) 781-9270
(612) 767-3490
Mailing address
1632 WASHINGTON ST NE, MINNEAPOLIS, MN 55413-1336
(612) 789-2853
(612) 767-9430
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/25/2018
Last updated
10/25/2018
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