| Larson Dental Llc | |
|
1632 Washington St Ne Minneapolis MN 55413-1336 | |
| (612) 789-2853 | |
| Not Available |
| Full Name | Larson Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 1632 Washington St Ne, Minneapolis, Minnesota |
| Authorized Official Name and Position | Cory J Larson (OWNER) |
| Authorized Official Contact | 6127892853 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Larson Dental Llc 1632 Washington St Ne Minneapolis MN 55413-1336 Ph: (612) 789-2853 | Larson Dental Llc 1632 Washington St Ne Minneapolis MN 55413-1336 Ph: (612) 789-2853 |
| NPI Number | 1922726280 |
|---|---|
| Provider Enumeration Date | 08/22/2022 |
| Last Update Date | 08/22/2022 |
| Medicare PECOS PAC ID | 3476921669 |
|---|---|
| Medicare Enrollment ID | O20221118001496 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922726280 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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