Provider Demographics
NPI:1609208826
Name:LARSON, CHAD EVANS (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:EVANS
Last Name:LARSON
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:1705 BROADWAY AVE S STE A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-7973
Mailing Address - Country:US
Mailing Address - Phone:507-288-4427
Mailing Address - Fax:507-288-8497
Practice Address - Street 1:1705 BROADWAY AVE S STE A
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-7973
Practice Address - Country:US
Practice Address - Phone:507-288-4427
Practice Address - Fax:507-288-8497
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN132311223X0400X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics