Provider Demographics
NPI:1699539635
Name:LARSEN, SETH ALAN
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:ALAN
Last Name:LARSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AUGUSTA UNIVERSITY THE DENTAL COLLEGE OF GEORGIA
Mailing Address - Street 2:1430 JOHN WESLEY GILBERT DRIVE
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AUGUSTA UNIVERSITY THE DENTAL COLLEGE OF GEORGIA
Practice Address - Street 2:1430 JOHN WESLEY GILBERT DRIVE
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0001
Practice Address - Country:US
Practice Address - Phone:706-721-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123988390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program