Healthcare Provider Details

I. General information

NPI: 1861634909
Provider Name (Legal Business Name): STEVEN SCOTT LARSEN D.D.S. M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E 200 N STE G
LOGAN UT
84321-6602
US

IV. Provider business mailing address

150 E 200 N STE G
LOGAN UT
84321-6602
US

V. Phone/Fax

Practice location:
  • Phone: 435-753-7668
  • Fax: 435-755-9815
Mailing address:
  • Phone: 435-753-7668
  • Fax: 435-755-9815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number09-00635
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: