Lake Havasu Orthodontics LLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

LAKE HAVASU ORTHODONTICS LLC

Practice address

2061 Smoketree Ave N
Lake Havasu City, AZ 86403-5811

Phone

(928) 854-4141

NPI assigned

Sep 8, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Ethan Larson, DMD, MSNPI 1083975759

Title

Doctor/Owner

Phone

(253) 283-2747

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ethan James Larson, D.M.D. M.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Gilbert, AZ
  • NPI 1083975759
  NPD (past) Authorized official
• Nathan Richard Yetter, DDS

  • Dentist
  • Mesa, AZ
  • NPI 1629089867

  Orthodontics and Dentofacial Orthopedics

  NPD (past)

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

{
    "created_epoch": "1662595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662595200000",
    "number": "1225759111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2212 E ARIS DR",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852981205",
            "telephone_number": "253-283-2747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2061 SMOKETREE AVE N",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035811",
            "telephone_number": "928-854-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HAVASU ORTHODONTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-08",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "253-283-2747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Havasu Family Eyecare, LLC
• Lake Havasu Imaging Center Inc
• Lake Havasu Medical Laboratory,LTD.
• Lake Havasu OB-GYN Care LLC
• Lake Havasu OB/GYN, PC
• Lake Havasu Primary Care PLLC
• Lake Havasu Radiology, PLLC
• Lake Havasu Too, LLC
• Lake Havasu Unified School Distrct
• Lake Havasu Unified School District #1

• Orthodontics and Dentofacial Orthopedics Dentistry in Lake Havasu City, AZ
• Providers in Lake Havasu City, 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 Sep 8, 2022; 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.