Provider Demographics
NPI:1568072213
Name:CHERYL LARSON, D.D.S. & ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:CHERYL LARSON, D.D.S. & ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-843-4255
Mailing Address - Street 1:294 NELSON RD
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1942
Mailing Address - Country:US
Mailing Address - Phone:231-843-4255
Mailing Address - Fax:231-425-3628
Practice Address - Street 1:294 NELSON RD
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1942
Practice Address - Country:US
Practice Address - Phone:231-843-4255
Practice Address - Fax:231-425-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty