Individual
MS. DANA DIANE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1212 E 4TH AVE, OLYMPIA, WA 98506
(360) 357-6220
(360) 352-5412
Mailing address
1212 E 4TH AVE, OLYMPIA, WA 98506
(360) 357-6220
(360) 352-5412
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7455
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
134017
L AND I
WA
01
—
5356001
DSHS
WA
01
—
831896
UNITED CONCORDIA
WA
01
—
9590
WASHINGTON DENTAL SERVICE
WA
Enumeration date
05/16/2007
Last updated
07/08/2007
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