Provider Demographics
NPI:1093934143
Name:LARSEN, JAMES D (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
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 3
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84636-0003
Mailing Address - Country:US
Mailing Address - Phone:435-795-2306
Mailing Address - Fax:
Practice Address - Street 1:110 W CENTER
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:UT
Practice Address - Zip Code:84636
Practice Address - Country:US
Practice Address - Phone:435-795-2306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT144305-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice