Healthcare Provider Details

I. General information

NPI: 1437156734
Provider Name (Legal Business Name): NOEL VEE LARSEN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2824 NE WASCO ST
PORTLAND OR
97232-1772
US

IV. Provider business mailing address

2824 NE WASCO ST
PORTLAND OR
97232-1772
US

V. Phone/Fax

Practice location:
  • Phone: 503-284-5678
  • Fax: 503-284-5556
Mailing address:
  • Phone: 503-284-5678
  • Fax: 503-284-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD6853
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: