Individual
DR. LAWRENCE ELLIOTT LISTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
2103 E WASHINGTON ST STE 2D, BLOOMINGTON, IL 61701-4365
(309) 663-5582
(309) 663-4683
Mailing address
2103 E WASHINGTON ST STE 2D, BLOOMINGTON, IL 61701-4365
(309) 663-5582
(309) 663-4683
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019019178
IL
Other
Enumeration date
11/13/2008
Last updated
11/13/2008
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