Provider Demographics
NPI:1245376961
Name:LARSON, CHRIS (DDS)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:LARSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:12777 VALLEY VIEW ST
Mailing Address - Street 2:#121
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845
Mailing Address - Country:US
Mailing Address - Phone:714-897-3543
Mailing Address - Fax:714-897-0505
Practice Address - Street 1:12777 VALLEY VIEW ST
Practice Address - Street 2:#121
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845
Practice Address - Country:US
Practice Address - Phone:714-897-3543
Practice Address - Fax:714-897-0505
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA31051204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery