Provider Demographics
NPI:1881671758
Name:LARSON, DALE C (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:C
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 1:7550 FRANCE AVE S
Mailing Address - Street 2:SUITE #138
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5624
Mailing Address - Country:US
Mailing Address - Phone:952-831-1332
Mailing Address - Fax:952-831-0553
Practice Address - Street 1:7550 FRANCE AVE S
Practice Address - Street 2:SUITE #138
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5624
Practice Address - Country:US
Practice Address - Phone:952-831-1332
Practice Address - Fax:952-831-0553
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND88051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice