Provider Demographics
NPI:1386710242
Name:KESO, LARSON RUSSELL (DDS)
Entity type:Individual
Prefix:DR
First Name:LARSON
Middle Name:RUSSELL
Last Name:KESO
Suffix:
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 1:3501 NORTHWEST 50TH
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5699
Mailing Address - Country:US
Mailing Address - Phone:405-943-8333
Mailing Address - Fax:405-947-1579
Practice Address - Street 1:3501 NORTHWEST 50TH
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5699
Practice Address - Country:US
Practice Address - Phone:405-943-8333
Practice Address - Fax:405-947-1579
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2625122300000X
OK371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics