Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. LARRY LEE NILLISSEN, DDS
ActiveDR. LARRY LEE NILLISSEN, DDS is a Dentist healthcare provider located in BIRNAMWOOD, Wisconsin. NPI 1518121284 is currently active in the NPPES registry. Verify at CMS.
Dentist · BIRNAMWOOD, WI
Registration Details
- NPI Number
- 1518121284
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 11, 2008 (18.121899466891 yrs)
- Last Updated
- Jul 11, 2008
- License
-
WI2723 (WI)
Practice Information
- Address
-
409A MAIN STBIRNAMWOOD, WI, 544140206Browse WI providers · Browse ZIP 54414
- Phone
- 7154493345
- Fax
- 7154493272
- Primary Specialty
-
Dentist
122300000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.