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General NPI Number Information
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NPI Number | 1003934464
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Entity Type | Organization
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Legal Business Name | LARSON AND ROELOFS FAMILY DENTISTRY INC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9327 MIDLOTHIAN TURNPIKE SUITE 1A
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City | RICHMOND
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State | VA
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Zip | 23235-4965
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Country | US
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Telephone | 804-323-3944
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Fax | 804-323-6007
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Provider Business Mailing Address
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Address Line | 9327 MIDLOTHIAN TURNPIKE SUITE 1A
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City | RICHMOND
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State | VA
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Zip | 23235-4965
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Country | US
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Telephone | 804-323-3944
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Fax | 804-323-6007
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID J LARSON
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Credential | DDS
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Telephone | 804-323-3944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401006446
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401006445
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License Number State | VA
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