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General NPI Number Information
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NPI Number | 1316805740
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Entity Type | Organization
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Legal Business Name | GREG D. LARSON, D.D.S, P.L.L.C.
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Dates
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Enumeration Date | 01/14/2026
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 6235 BLAKENEY PARK DR STE 101
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City | CHARLOTTE
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State | NC
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Zip | 28277-5658
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Country | US
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Telephone | 704-220-1930
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Fax |
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Provider Business Mailing Address
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Address Line | 6235 BLAKENEY PARK DR STE 101
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City | CHARLOTTE
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State | NC
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Zip | 28277-5658
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Country | US
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Telephone | 704-220-1930
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Fax |
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Authorized Official
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Title or Position | PRACTICE DIRECTOR
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Name | RACHELLE LARSON
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Credential |
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Telephone | 415-608-9908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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