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General NPI Number Information
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NPI Number | 1033276357
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Entity Type | Individual
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Provider Name | STEPHEN JOSEPH LARSON DDS
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Gender | Male
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 612 ROCKDALE AVE
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City | CINCINNATI
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State | OH
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Zip | 45229-2919
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Country | US
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Telephone | 513-352-4072
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Fax |
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Provider Business Mailing Address
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Address Line | 497 CINCINNATI BATAVIA PIKE
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City | CINCINNATI
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State | OH
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Zip | 45244-0249
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Country | US
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Telephone | 513-528-1223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 30022411
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License Number State | OH
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