Provider Demographics
NPI:1437267598
Name:KIM F LARSON
Entity Type:Organization
Organization Name:KIM F LARSON
Other - Org Name:LARSON DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-789-2853
Mailing Address - Street 1:1632 WASHINGTON ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1336
Mailing Address - Country:US
Mailing Address - Phone:612-789-2853
Mailing Address - Fax:612-789-9413
Practice Address - Street 1:1632 WASHINGTON ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1336
Practice Address - Country:US
Practice Address - Phone:612-789-2853
Practice Address - Fax:612-789-9413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty