Provider Demographics
NPI:1598890063
Name:LARSEN, TODD S (DMD)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:S
Last Name:LARSEN
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 1:8915 S 700 E STE 103
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2421
Mailing Address - Country:US
Mailing Address - Phone:801-562-2147
Mailing Address - Fax:801-569-1795
Practice Address - Street 1:8915 S 700 E STE 103
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2421
Practice Address - Country:US
Practice Address - Phone:801-562-2147
Practice Address - Fax:801-569-1795
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0147211223G0001X
UT360817-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice