Provider Demographics
NPI:1508870627
Name:LARSEN, LAWRENCE JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOSEPH
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 1:7210 GREENHAVEN DR STE B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3576
Mailing Address - Country:US
Mailing Address - Phone:916-395-0901
Mailing Address - Fax:916-395-8708
Practice Address - Street 1:7210 GREENHAVEN DR STE B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3576
Practice Address - Country:US
Practice Address - Phone:916-395-0901
Practice Address - Fax:916-395-8708
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice