Provider Demographics
NPI:1033407531
Name:LARSEN, AARON DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:DAVID
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:PO BOX 2320
Mailing Address - Street 2:
Mailing Address - City:GLENROCK
Mailing Address - State:WY
Mailing Address - Zip Code:82637-2320
Mailing Address - Country:US
Mailing Address - Phone:307-436-8770
Mailing Address - Fax:307-436-8771
Practice Address - Street 1:925 WBIRCH
Practice Address - Street 2:
Practice Address - City:GLENROCK
Practice Address - State:WY
Practice Address - Zip Code:82637
Practice Address - Country:US
Practice Address - Phone:307-436-8770
Practice Address - Fax:307-436-8771
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY12781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice