Provider Demographics
NPI:1881900918
Name:LARSON, LEAH PILLET (DDS)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:PILLET
Last Name:LARSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 SEVENOAKS AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7657
Mailing Address - Country:US
Mailing Address - Phone:225-802-6097
Mailing Address - Fax:
Practice Address - Street 1:7520 PERKINS RD
Practice Address - Street 2:SUITE 310
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9111
Practice Address - Country:US
Practice Address - Phone:225-769-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist