Provider Demographics
NPI:1710395710
Name:LARSEN, IHSAN BURAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:IHSAN
Middle Name:BURAK
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 1:260 SUMMIT BLVD
Mailing Address - Street 2:APT 8304
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8358
Mailing Address - Country:US
Mailing Address - Phone:719-314-8103
Mailing Address - Fax:
Practice Address - Street 1:2250 S MONACO PKWY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5814
Practice Address - Country:US
Practice Address - Phone:303-476-6233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202291122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist