NPI 1710171483 · live from the CMS NPI Registry
Robert Gardner Larson, DDS MSD
Dentist, Orthodontics and Dentofacial Orthopedics in Indianapolis, IN. National Provider Identifier 1710171483, active.
NPI record
| NPI | 1710171483 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist, Orthodontics and Dentofacial Orthopedics 1223X0400X |
| Practice location | 6070 N Keystone Ave, Indianapolis, IN 46220 |
| Practice phone | 317-253-6784 |
| Enumerated | September 5, 2007 |
| Last updated | September 5, 2007 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist | 122300000X | 8110 (IN) |
| Dentist, Orthodontics and Dentofacial Orthopedics primary | 1223X0400X | 8110 (IN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.