Provider Demographics
NPI:1700016516
Name:LARSON, KYRA RHODES (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYRA
Middle Name:RHODES
Last Name:LARSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E GATES ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-2548
Mailing Address - Country:US
Mailing Address - Phone:715-864-9183
Mailing Address - Fax:
Practice Address - Street 1:15541W HWY 77 EAST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843
Practice Address - Country:US
Practice Address - Phone:715-634-6776
Practice Address - Fax:715-634-5859
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6412-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist