NPIMap

Organization Active NPI

Larsen Dental Care

  • General Practice Dentistry
  • Pocatello, ID
National Provider Identifier
1104061449
Registry record updated Dec 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D-3894 Issued in ID
Legal business name
LARSEN DENTAL CARE
Practice address
950 Hospital Way
Suite B
Pocatello, ID 83201-2789
Phone
(208) 233-7007
Fax
(208) 233-2512
NPI assigned
Dec 15, 2008
Last updated
Dec 15, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2008

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

Authorized official

Name
Dr. Bryce R Larsen, D.M.D.NPI 1821210535
Title
Dentist Owner
Phone
(208) 233-7007

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D-1599 ID
General Practice Dentistry 1223G0001X D-3894 ID Primary

Addresses

Primary practice location

950 Hospital Way
Suite B
Pocatello, ID 83201-2789

Mailing address

950 Hospital Way
Suite B
Pocatello, ID 83201-2789
Phone (208) 233-7007

Other identifiers 1

IdentifierTypeStateIssuer
8072105MedicaidID

National Provider Directory

National Provider Directory

Locations

950 Hospital Way
#B
Pocatello, ID 83201
Phone (208) 233-7007

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1229299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229299200000",
    "number": "1104061449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 HOSPITAL WAY",
            "address_2": "SUITE B",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012789",
            "telephone_number": "208-233-7007",
            "fax_number": "208-233-2512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 HOSPITAL WAY",
            "address_2": "SUITE B",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012789",
            "telephone_number": "208-233-7007",
            "fax_number": "208-233-2512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARSEN DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-15",
        "last_updated": "2008-12-15",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "BRYCE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "208-233-7007",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-1599",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3894",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8072105",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2008; 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.