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General NPI Number Information
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NPI Number | 1336770528
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Entity Type | Organization
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Legal Business Name | CRAIG G. LARSON, DDS PLLC
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 2051 TERRY ST STE F
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City | LONGMONT
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State | CO
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Zip | 80501-1872
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Country | US
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Telephone | 303-678-7232
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Fax | 303-678-7043
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Provider Business Mailing Address
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Address Line | 2051 TERRY ST STE F
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City | LONGMONT
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State | CO
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Zip | 80501-1872
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Country | US
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Telephone | 303-678-7232
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Fax | 303-678-7043
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Authorized Official
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Title or Position | DENTIST/ OWNER
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Name | DR. CRAIG LARSON
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Credential | DDS
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Telephone | 303-678-7232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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