Individual
DALLIN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3240 E LOUISE DR, MERIDIAN, ID 83642-5107
(208) 898-8866
Mailing address
2289 N MONTGOMERY AVE, MERIDIAN, ID 83646-8819
(208) 859-4112
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
D-5309-EN
ID
Other
Enumeration date
03/10/2018
Last updated
07/01/2021
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