Individual
DR. JENNIFER SUE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
216 N LAKE ST, BOYNE CITY, MI 49712-1210
(231) 582-4480
(231) 582-4460
Mailing address
216 N LAKE ST, BOYNE CITY, MI 49712-1210
(231) 350-6747
(231) 582-4460
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901019425
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2901019425
STATE OF MICHIGAN BOARD OF DENTISTRY
MI
05
—
4916278
—
MI
Enumeration date
11/01/2006
Last updated
07/06/2020
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