Provider Demographics
NPI:1073649190
Name:LARSEN, CAROLYN PETERS (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:PETERS
Last Name:LARSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 APPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2172
Mailing Address - Country:US
Mailing Address - Phone:563-355-4544
Mailing Address - Fax:563-355-5210
Practice Address - Street 1:2322 E KIMBERLY RD
Practice Address - Street 2:SUITE 200W
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-7205
Practice Address - Country:US
Practice Address - Phone:563-355-4544
Practice Address - Fax:563-355-5210
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA71971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice