Provider Demographics
NPI:1346446150
Name:LARSON, SCOTT ANDREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANDREW
Last Name:LARSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 REGENCY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6325
Mailing Address - Country:US
Mailing Address - Phone:801-599-0910
Mailing Address - Fax:
Practice Address - Street 1:928 E 100 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1455
Practice Address - Country:US
Practice Address - Phone:801-355-3322
Practice Address - Fax:801-322-0629
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT23633521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice