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General NPI Number Information
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NPI Number | 1710577416
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Entity Type | Organization
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Legal Business Name | LARS KORSMO, D.D.S., PLLC
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 2520 N ALDER ST
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City | TACOMA
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State | WA
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Zip | 98406-6632
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Country | US
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Telephone | 253-759-5414
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Fax |
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Provider Business Mailing Address
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Address Line | 2520 N ALDER ST
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City | TACOMA
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State | WA
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Zip | 98406-6632
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Country | US
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Telephone | 253-759-5414
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. LARS K.C. KORSMO
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Credential | D.D.S.
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Telephone | 253-759-5414
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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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