Individual
DR. MARK ANTHONY LARUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1647 TAUSSIG BOULEVARD, NAVAL DENTAL CLINIC NORFOLK, NORFOLK, VA 23511-2896
(757) 953-8698
Mailing address
2205 LEEWAY CT, VIRGINIA BEACH, VA 23455-1699
(757) 363-0321
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0401411249
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
IL
Other
Enumeration date
09/30/2005
Last updated
09/05/2007
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