Individual
GREGG STUART LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1900 CENTRACARE CIRCLE, STE 0350, ST CLOUD, MN 56303-5000
(320) 253-0272
(320) 251-2661
Mailing address
1900 CENTRACARE CIRCLE, STE 0350, ST CLOUD, MN 56303-5000
(320) 253-0272
(320) 251-2661
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
11344
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286909800
—
MN
01
—
294L9LA
BLUE CROSS BLUE SHIELD
MN
01
—
HP37202
HEALTH PARTNERS
MN
Enumeration date
06/09/2006
Last updated
10/02/2014
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