Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 30022411 | OH |
NPI | 1033276357 |
---|---|
Provider Name | Dr. Stephen Joseph Larson |
First Address | Cincinnati, OH 45244-0249 |
Second Address | Cincinnati, OH 45229-2919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2679981 | (05) | OH |