David Darrell Larson, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

01916418 Issued in IL

Practice address

6415 Forest Hills Road
Rockford, IL 61114

Phone

(815) 654-9552

Fax

(915) 654-7521

NPI assigned

Dec 1, 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

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174691752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6415 FOREST HILLS ROAD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61114",
            "telephone_number": "815-654-9552",
            "fax_number": "915-654-7521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6415 FOREST HILLS ROAD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61114",
            "telephone_number": "815-654-9552",
            "fax_number": "915-654-7521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "DAVID",
        "middle_name": "DARRELL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "01916418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angelique Langlois
• Pierre Lanthiez, MD
• Amanda Maria Lantow, PMHNP
• Mary Elizabeth Lapier, PT
• Christine Elizabeth Larson, PA
• Kathleen A. Larson, O.T.
• Kelley Nicole Larson, LSW
• Kerry Larson
• Lisa A. Larson, APRN
• Mae Marie Larson

• Dentist in Rockford, IL
• Providers in Rockford, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.