Provider Demographics
NPI:1669452678
Name:LARSON, MARK P (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:P
Last Name:LARSON
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 1:278 STAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:CAPE CARTERET
Mailing Address - State:NC
Mailing Address - Zip Code:28584-8933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:278 STAR HILL DR
Practice Address - Street 2:
Practice Address - City:CAPE CARTERET
Practice Address - State:NC
Practice Address - Zip Code:28584-8933
Practice Address - Country:US
Practice Address - Phone:252-466-0410
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL114791223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics