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General NPI Number Information
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NPI Number | 1578948683
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Entity Type | Organization
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Legal Business Name | JAMES E. LARSON DDS, MSD
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 1829 GUNBARREL RD SUITE A
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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 | PO BOX 28047
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City | CHATTANOOGA
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State | TN
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Zip | 37424-8047
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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 | OWNER
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Name | JAMES E LARSON
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Credential | DDS, MSD
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Telephone | 423-296-0407
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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 | 4503
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License Number State | TN
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