| Dr Robert L Larison PC | |
|
1214 S 4th St Springfield IL 62703-2229 | |
| (217) 528-1502 | |
| (217) 528-7448 |
| Full Name | Dr Robert L Larison PC |
|---|---|
| Speciality | Dentist |
| Location | 1214 S 4th St, Springfield, Illinois |
| Authorized Official Name and Position | Robert L Larison (PRESIDENT) |
| Authorized Official Contact | 2175281502 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Robert L Larison PC 1214 S 4th St Springfield IL 62703-2229 Ph: (217) 528-1502 | Dr Robert L Larison PC 1214 S 4th St Springfield IL 62703-2229 Ph: (217) 528-1502 |
| NPI Number | 1447477849 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447477849 | NPI | - | NPPES |
| 1002641 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (Illinois) | Primary |
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