Provider Demographics
NPI:1790812378
Name:LARRABEE, CRAIG W (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:W
Last Name:LARRABEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 E BELLEVIEW PL
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4225
Mailing Address - Country:US
Mailing Address - Phone:414-963-9440
Mailing Address - Fax:262-241-4614
Practice Address - Street 1:2532 E BELLEVIEW PL
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4225
Practice Address - Country:US
Practice Address - Phone:414-963-9440
Practice Address - Fax:262-241-4614
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice