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General NPI Number Information
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NPI Number | 1558351593
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Entity Type | Individual
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Provider Name | JAMES EDWARD LARSON D.D.S., M.S.D.
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Gender | Male
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1829 GUNBARREL RD SUITE A-1
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7184
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Country | US
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Telephone | 423-296-0407
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Fax | 423-296-0174
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Provider Business Mailing Address
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Address Line | 1829 GUNBARREL RD SUITE A-1
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City | CHATTANOOGA
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State | TN
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Zip | 37421-7184
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Country | US
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Telephone | 423-296-0407
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Fax | 423-296-0174
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS0000004503
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License Number State | TN
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