Individual
DR. ROBERT GARDNER LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS MSD
Contact information
Practice address
6070 N KEYSTONE AVE, INDIANAPOLIS, IN 46220-2585
(317) 253-6784
(317) 803-9917
Mailing address
6070 N KEYSTONE AVE, INDIANAPOLIS, IN 46220-2585
(317) 253-6784
(317) 803-9917
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8110
IN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
8110
IN
Other
Enumeration date
09/05/2007
Last updated
09/05/2007
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