William Kim Larson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12083 Issued in MN

Practice address

122 Colfax Ave SW
Wadena, MN 56482-1470

Phone

(218) 631-4525

Fax

(218) 631-3998

NPI assigned

Oct 6, 2006

Sex

Male

Sole proprietor

No

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

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 and National Provider Directory roles.

• Wadena Family Dental, P. a.

  • General Practice Dentistry
  • Wadena, MN
  • NPI 1881864049
  NPD (past) Authorized official

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184544000000",
    "number": "1164519625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 COLFAX AVE SW",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564821470",
            "telephone_number": "218-631-4525",
            "fax_number": "218-631-3998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 COLFAX AVE SW",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564821470",
            "telephone_number": "218-631-4525",
            "fax_number": "218-631-3998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "WILLIAM",
        "middle_name": "KIM",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2007-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jim Kraemer
• Nyla J Kraemer
• Magaen Kveton, APRN, CNP, FNP-BC
• Leonard Kenneth Lamberty, M.D.
• Kammy Larson
• Betsy Jo Lewis
• Brett Lien, PT, DPT
• John Lindblom, DO
• Megan Elizabeth Lindblom, PHARMD
• Macayla Rose Lindenfelser, NP-C

• General Practice Dentistry in Wadena, MN
• Providers in Wadena, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.