Provider Demographics
NPI:1922213735
Name:LARSEN, DAREN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAREN
Middle Name:L
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 1:1169 W HIGHWAY 40 STE C
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2911
Mailing Address - Country:US
Mailing Address - Phone:435-781-2729
Mailing Address - Fax:435-781-2719
Practice Address - Street 1:1169 W HIGHWAY 40 STE C
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2911
Practice Address - Country:US
Practice Address - Phone:435-781-2729
Practice Address - Fax:435-781-2719
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT341186-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice