Provider Demographics
NPI:1952478489
Name:LARSON, ROBERT FRANK
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANK
Last Name:LARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 4TH AVE NW
Mailing Address - Street 2:PO BOX 70
Mailing Address - City:ROSEAU
Mailing Address - State:MN
Mailing Address - Zip Code:56751-1033
Mailing Address - Country:US
Mailing Address - Phone:218-463-2553
Mailing Address - Fax:
Practice Address - Street 1:201 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:ROSEAU
Practice Address - State:MN
Practice Address - Zip Code:56751-1033
Practice Address - Country:US
Practice Address - Phone:218-463-2553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN84721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice