Provider Demographics
NPI:1447435656
Name:LARSON, EDWIN VERNOR JR (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:VERNOR
Last Name:LARSON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:153 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3361
Mailing Address - Country:US
Mailing Address - Phone:802-229-4225
Mailing Address - Fax:802-229-9944
Practice Address - Street 1:153 STATE ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3361
Practice Address - Country:US
Practice Address - Phone:802-229-4225
Practice Address - Fax:802-229-9944
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00012081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics