Provider Demographics
NPI:1497773725
Name:LARSEN, GREGORY PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PAUL
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 1:7370 S CREEK ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6105
Mailing Address - Country:US
Mailing Address - Phone:801-566-4100
Mailing Address - Fax:801-562-2152
Practice Address - Street 1:7370 S CREEK ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6105
Practice Address - Country:US
Practice Address - Phone:801-566-4100
Practice Address - Fax:801-562-2152
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9427213799221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice