Individual
BRENT EVANS LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
515 DELAWARE ST SE, ORTHODONTICS CLINIC, MINNEAPOLIS, MN 55455-0357
(612) 626-6529
Mailing address
515 DELAWARE ST SE, SCHOOL OF DENTISTRY, MINNEAPOLIS, MN 55455-0357
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D9175
MN
Other
Enumeration date
09/26/2006
Last updated
08/14/2007
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