Provider Demographics
NPI:1083617435
Name:LARSON, DONALD F (ORTHODONTIST)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:F
Last Name:LARSON
Suffix:
Gender:M
Credentials:ORTHODONTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 N SAINT ASAPH ST
Mailing Address - Street 2:FL 2
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1718
Mailing Address - Country:US
Mailing Address - Phone:703-838-8998
Mailing Address - Fax:703-838-2714
Practice Address - Street 1:814 N SAINT ASAPH ST
Practice Address - Street 2:FL 2
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1718
Practice Address - Country:US
Practice Address - Phone:703-838-8998
Practice Address - Fax:703-838-2714
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2012-02-29
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
VA04010088961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics