Provider Demographics
NPI:1922583210
Name:LARSEN, BRYAN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:T
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 1:1305 WESTLOOP PL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2841
Mailing Address - Country:US
Mailing Address - Phone:785-539-5949
Mailing Address - Fax:785-539-2717
Practice Address - Street 1:1305 WESTLOOP PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2841
Practice Address - Country:US
Practice Address - Phone:785-539-5949
Practice Address - Fax:785-539-2717
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE613931223G0001X
KS61393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice