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General NPI Number Information
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NPI Number | 1710395710
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Entity Type | Individual
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Provider Name | IHSAN BURAK LARSEN DDS
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Gender | Male
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 2250 S MONACO PKWY
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City | DENVER
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State | CO
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Zip | 80222-5814
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Country | US
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Telephone | 303-476-6233
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Fax |
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Provider Business Mailing Address
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Address Line | 260 SUMMIT BLVD APT 8304
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City | BROOMFIELD
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State | CO
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Zip | 80021-8358
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Country | US
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Telephone | 719-314-8103
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 00202291
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License Number State | CO
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