Healthcare Provider Details

I. General information

NPI: 1578704169
Provider Name (Legal Business Name): THOMAS H LARSON DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 N FRESNO ST SUITE 105
FRESNO CA
93720-2413
US

IV. Provider business mailing address

7780 N FRESNO ST SUITE 105
FRESNO CA
93720-2413
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-9701
  • Fax: 559-431-9121
Mailing address:
  • Phone: 559-431-9701
  • Fax: 559-431-9121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number25928
License Number StateCA

VIII. Authorized Official

Name: DR. THOMAS HARTMAN LARSON
Title or Position: PEDIATRIC DENTIST, OWNER
Credential: DDS
Phone: 559-431-9701