Individual
PAUL LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1704 PATTON DR STE 1, MAHOMET, IL 61853-8137
(203) 530-3136
Mailing address
165 W UNIVERSITY DR, MISHAWAKA, IN 46545-1199
(574) 271-1060
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019018482
IL
122300000X
Dentist
12008917A
IN
Other
Enumeration date
11/02/2006
Last updated
01/09/2026
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