Ethan James Larson, D.M.D. M.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

D011332 Issued in AZ

Practice address

4365 E Pecos Rd Ste 136
Gilbert, AZ 85295-8053

Phone

(480) 712-9595

NPI assigned

May 30, 2012

Last updated

Nov 15, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Avelle Lichfield Ortho LLC

  dba Avelle Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Goodyear, AZ
  • NPI 1770307704
  NPD Authorized official
• Avelle Gilbert Ortho LLC

  dba Avelle Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Gilbert, AZ
  • NPI 1538867460
  Authorized official Same address or phone
• Lake Havasu Orthodontics LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Lake Havasu City, AZ
  • NPI 1225759111
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731628800000",
    "number": "1083975759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4365 E PECOS RD STE 136",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852958053",
            "telephone_number": "480-712-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4365 E PECOS RD STE 136",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852958053",
            "telephone_number": "480-712-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "ETHAN",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.M.D. M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-05-30",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "AZ",
            "license": "D011332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Larsen
• Michelle Larsen, NP
• Scott Craig Larsen, DDS
• David M Larson, MD
• Emmalee Larson, OTR/L
• Julia Larson
• Nathan Larson
• Tara Lynn Larson, MS OTR/L
• Zenda P Lasao, PA-C
• Matthew Lasinis

• Orthodontics and Dentofacial Orthopedics Dentistry in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.