Individual
DR. GREGG A LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2716 UPPER AFTON ROAD, SAINT PAUL, MN 55119-4780
(651) 739-5110
(651) 739-1873
Mailing address
2716 UPPER AFTON ROAD, SAINT PAUL, MN 55119-4780
(651) 739-5110
(651) 739-1873
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7974
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
660715200
—
MN
Enumeration date
11/30/2006
Last updated
07/08/2007
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