Provider Demographics
NPI:1891841433
Name:LARSEN, AARON (DMD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:
Last Name:LARSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 KOBUK CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5833
Mailing Address - Country:US
Mailing Address - Phone:770-433-2046
Mailing Address - Fax:
Practice Address - Street 1:2460 CUMBERLAND PKWY SE
Practice Address - Street 2:SUITE 210
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4519
Practice Address - Country:US
Practice Address - Phone:770-433-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013092122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist