Provider Demographics
NPI:1033378328
Name:LARSEN, RALPH T (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:T
Last Name:LARSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 E 5600 S
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1351
Mailing Address - Country:US
Mailing Address - Phone:801-277-8395
Mailing Address - Fax:801-277-5443
Practice Address - Street 1:1949 E 5600 S
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1351
Practice Address - Country:US
Practice Address - Phone:801-277-8395
Practice Address - Fax:801-277-5443
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT132834-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice