Individual
DR. CANON LARSON NIELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5700 RALSTON ST, SUITE 303, VENTURA, CA 93003-6050
(805) 656-8884
Mailing address
5700 RALSTON ST, SUITE 303, VENTURA, CA 93003-6050
(805) 656-8884
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
62052
CA
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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