Susan Michelle Larsen, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D5678 Issued in AZ

Practice address

1245 E Southern Ave
Ste 12
Mesa, AZ 85204-5137

Phone

(480) 610-6544

Fax

(480) 633-0670

NPI assigned

Oct 2, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Susan Michelle Matchinsky Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Dentistry for Children PLLC

  • Dentist
  • Mesa, AZ
  • NPI 1154540367
  NPD (past)

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1114010188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 E SOUTHERN AVE",
            "address_2": "STE 12",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852045137",
            "telephone_number": "480-610-6544",
            "fax_number": "480-633-0670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 E SOUTHERN AVE",
            "address_2": "STE 12",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852045137",
            "telephone_number": "480-610-6544",
            "fax_number": "480-633-0670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "SUSAN",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D5678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "703323",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "MATCHINSKY",
            "middle_name": "MICHELLE",
            "prefix": "MS.",
            "credential": "D.D.S.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Daniel Justin Larsen
• Hailey Larsen, RBT
• Jamie P Larsen, PAC
• Lily Larsen, PHARMD
• Moriah Larsen, AT/L, ATC
• Larson Endeavors PLLC (Orthopedic & Sports Specialists)
• Aaron Jay Larson, ATC
• Ayn Larson, PA
• Jason Rex Larson, CRNA
• Jennifer Larson, DNP, CNM, CPM

• Dentist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.