Provider Demographics
NPI:1972633907
Name:LARSON, CRAIG G (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:G
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 1:3445 PENROSE PL STE 110
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1874
Mailing Address - Country:US
Mailing Address - Phone:303-444-4166
Mailing Address - Fax:303-444-3489
Practice Address - Street 1:3445 PENROSE PL STE 110
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1874
Practice Address - Country:US
Practice Address - Phone:303-444-4166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO91681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice