Provider Demographics
NPI:1023423258
Name:LARSEN, CHASE (DMD)
Entity type:Individual
Prefix:DR
First Name:CHASE
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 1:723 E 12200 S STE 101
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9885
Mailing Address - Country:US
Mailing Address - Phone:801-683-5239
Mailing Address - Fax:
Practice Address - Street 1:723 E 12200 S STE 101
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9885
Practice Address - Country:US
Practice Address - Phone:801-683-5239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD45911223G0001X
UT9361973-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice