| Vernon A. Larsen D.d.s., S.c. | |
|
59 Racine St Menasha WI 54952-3133 | |
| (920) 722-4293 | |
| (920) 722-3394 |
| Full Name | Vernon A. Larsen D.d.s., S.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 59 Racine St, Menasha, Wisconsin |
| Authorized Official Name and Position | Vernon A Larsen (PRESIDENT) |
| Authorized Official Contact | 9207224293 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vernon A. Larsen D.d.s., S.c. 59 Racine St Menasha WI 54952-3133 Ph: (920) 722-4293 | Vernon A. Larsen D.d.s., S.c. 59 Racine St Menasha WI 54952-3133 Ph: (920) 722-4293 |
| NPI Number | 1396768669 |
|---|---|
| Provider Enumeration Date | 07/26/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396768669 | NPI | - | NPPES |
| 33600000 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 4001803 (Wisconsin) | Primary |
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