Provider Demographics
NPI:1710577416
Name:LARS KORSMO, D.D.S., PLLC
Entity Type:Organization
Organization Name:LARS KORSMO, D.D.S., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARS
Authorized Official - Middle Name:KC
Authorized Official - Last Name:KORSMO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-759-5414
Mailing Address - Street 1:2520 N ALDER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-6632
Mailing Address - Country:US
Mailing Address - Phone:253-759-5414
Mailing Address - Fax:
Practice Address - Street 1:2520 N ALDER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-6632
Practice Address - Country:US
Practice Address - Phone:253-759-5414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental