Provider Demographics
NPI:1356437354
Name:LARSON, MARC (DDS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:LARSON
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6886 INDIANA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4218
Mailing Address - Country:US
Mailing Address - Phone:951-686-6410
Mailing Address - Fax:951-680-1755
Practice Address - Street 1:6886 INDIANA AVE STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4218
Practice Address - Country:US
Practice Address - Phone:951-686-6410
Practice Address - Fax:951-680-1755
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA472751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics