Healthcare Provider Details

I. General information

NPI: 1629027040
Provider Name (Legal Business Name): STEVEN J LARSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15541 HIGHWAY 77 E
HAYWARD WI
54843-6684
US

IV. Provider business mailing address

15541 HIGHWAY 77 E
HAYWARD WI
54843-6684
US

V. Phone/Fax

Practice location:
  • Phone: 715-634-6776
  • Fax: 715-634-5859
Mailing address:
  • Phone: 715-634-6776
  • Fax: 715-634-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5001771015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: