Provider Demographics
NPI:1366040156
Name:LARSEN, ANN ELIZABETH (RDH BS)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:ELIZABETH
Last Name:LARSEN
Suffix:
Gender:F
Credentials:RDH BS
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH BS
Mailing Address - Street 1:1182 CAMP EDEN RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-8630
Mailing Address - Country:US
Mailing Address - Phone:303-801-7569
Mailing Address - Fax:
Practice Address - Street 1:4800 TABOR ST
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2112
Practice Address - Country:US
Practice Address - Phone:303-421-4161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000903174124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist