Provider Demographics
NPI:1972765857
Name:STEIN, LARISA (DMD)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:STEIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 WASHINGTON ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3579
Mailing Address - Country:US
Mailing Address - Phone:781-762-6688
Mailing Address - Fax:
Practice Address - Street 1:661 WASHINGTON ST
Practice Address - Street 2:SUITE 211
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3579
Practice Address - Country:US
Practice Address - Phone:781-762-6688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0170931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice