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NPI Code Detail

MEDICARE: ANN ELIZABETH LARSEN RDH BS

MEDICARE: ANN ELIZABETH LARSEN RDH BS
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
1124Q00000XDental Hygienist000903174CO

General Provider Information

NPI Number : 1366040156
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANN ELIZABETH LARSEN RDH BS
Provider Business Mailing Address
First Line : 1182 CAMP EDEN RD
Second Line :
City : GOLDEN
State : CO
Zip : 80403-8630
Country : US
Telephone Number : 303-801-7569
Fax Number :
Provider Business Practice Location Address
First Line : 4800 TABOR ST
Second Line :
City : WHEAT RIDGE
State : CO
Zip : 80033-2112
Country : US
Telephone Number : 303-421-4161
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2020
Last Update Date : 10/13/2020

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