Provider Demographics
NPI:1922144260
Name:LARSON, NANCY YVONNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:YVONNE
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 1:10562 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5537
Mailing Address - Country:US
Mailing Address - Phone:262-240-1220
Mailing Address - Fax:262-240-1232
Practice Address - Street 1:10562 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5537
Practice Address - Country:US
Practice Address - Phone:262-240-1220
Practice Address - Fax:262-240-1232
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice