Individual
MARY LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
47766 VAN DYKE AVE, SHELBY TOWNSHIP, MI 48317-3370
(586) 500-7626
Mailing address
12193 FOREST GLEN LN, SHELBY TOWNSHIP, MI 48315-1761
(630) 488-2203
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901602531
MI
Other
Enumeration date
06/11/2025
Last updated
06/11/2025
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