MEDICARE: SOPHIA LARSEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	13840	NC

General Provider Information

NPI Number	:	1255161303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA LARSEN DDS

Provider Business Mailing Address
First Line	:	200 DISTRICT DR APT 210
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28803-0238
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 OLD FORT RD
Second Line	:
City	:	FAIRVIEW
State	:	NC
Zip	:	28730-9758
Country	:	US
Telephone Number	:	828-628-3504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	08/05/2024

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