Individual
SANDRA SUE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1919 SOUTH 40TH ST, SUITE 105, LINCOLN, NE 68506-5247
(402) 483-1054
(402) 483-1056
Mailing address
1919 SOUTH 40TH ST, SUITE 105, LINCOLN, NE 68506-5247
(402) 483-1054
(402) 483-1056
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5345
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47072666100
—
NE
Enumeration date
12/14/2006
Last updated
07/08/2007
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