Individual
DR. DANIEL ALLEN LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
317 E KIMBERLY AVE, KIMBERLY, WI 54136-1406
(920) 788-2871
(192) 078-8287
Mailing address
317 E KIMBERLY AVE, KIMBERLY, WI 54136-1406
(920) 788-2871
(192) 078-8287
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001350
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5001350
STATE DENTAL LICENSE
WI
Enumeration date
01/09/2007
Last updated
07/08/2007
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