Provider Demographics
NPI:1801867197
Name:LARSON, ROBERT OWEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:OWEN
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 1:15101 E ILIFF AVE
Mailing Address - Street 2:SUITE NUMBER 280
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4543
Mailing Address - Country:US
Mailing Address - Phone:303-696-1899
Mailing Address - Fax:303-696-6308
Practice Address - Street 1:15101 E ILIFF AVE
Practice Address - Street 2:SUITE NUMBER 280
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4543
Practice Address - Country:US
Practice Address - Phone:303-696-1899
Practice Address - Fax:303-696-6308
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COH-D-1-047381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice