MEDICARE: LEAH PILLET LARSON D.D.S.

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	122300000X	Dentist	6258	LA

General Provider Information

NPI Number	:	1881900918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH PILLET LARSON D.D.S.

Provider Business Mailing Address
First Line	:	8040 SEVENOAKS AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-7657
Country	:	US
Telephone Number	:	225-802-6097
Fax Number	:

Provider Business Practice Location Address
First Line	:	7520 PERKINS RD
Second Line	:	SUITE 310
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-9111
Country	:	US
Telephone Number	:	225-769-0031
Fax Number	:

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

Provider Enumeration Date	:	08/26/2010
Last Update Date	:	02/24/2016

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