Provider Demographics
NPI:1184750036
Name:LARSON, DAVID ROY (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROY
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 1:1305 MIDDLETOWN RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-8825
Mailing Address - Country:US
Mailing Address - Phone:717-566-9797
Mailing Address - Fax:717-566-4627
Practice Address - Street 1:1305 MIDDLETOWN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-8825
Practice Address - Country:US
Practice Address - Phone:717-566-9797
Practice Address - Fax:717-566-4627
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029119L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice