Larson, Douglas Marshall

Larson, Douglas Marshall is an sole proprietor health care provider with primary practice located at 680 Fairmount Ave , Jamestown NY 14701-2630. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / Orthodontics and Dentofacial Orthopedics. Dental Providers / Orthodontics and Dentofacial Orthopedics is his primary health care specialty. Larson, Douglas Marshall can be contacted via phone (716) 483-1718.

Contact Information

Primary practice address
680 Fairmount Ave Jamestown NY 14701-2630
Phone: (716) 483-1718
Fax: (716) 661-9623
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 049 677 New York
Dental Providers / Orthodontics and Dentofacial Orthopedics 1223X0400X 049 677 New York

Profile Details

NPI number 1366432098
LBN Legal business name Larson, Douglas Marshall
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 25th, 2005
Last updated May 12th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1366432098 NPPES
New York MEDICAID 02740834

Popular Providers