Healthcare Provider Details

I. General information

NPI: 1306258991
Provider Name (Legal Business Name): RYAN K. LARSEN DMD & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 GRAND AVE #198
BILLINGS MT
59102
US

IV. Provider business mailing address

3031 GRAND AVE #198
BILLINGS MT
59102
US

V. Phone/Fax

Practice location:
  • Phone: 406-855-0844
  • Fax: 406-969-6659
Mailing address:
  • Phone: 801-360-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number7687
License Number StateMT

VIII. Authorized Official

Name: DR. RYAN K. LARSEN
Title or Position: PRESIDENT
Credential: DMD
Phone: 406-855-0844