Larsen Family Dental S.C.

Primary specialty

DentistTaxonomy code 122300000X

License

500159515 Issued in WI

Legal business name

LARSEN FAMILY DENTAL S.C.

Practice address

215 N. Spring Street
Beaver Dam, WI 53916

Phone

(920) 885-6066

Fax

(920) 885-6192

NPI assigned

May 12, 2006

Last updated

Aug 23, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Andrea K Larsen, DDSNPI 1629362017

Title

Owner

Phone

(920) 885-6066

Specialties & licenses 1

Addresses

Other names 1

• Mark Barrette DDS, S.C. Former legal business name

Locations

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.

• Andrea Kay Larsen, DDS

  • Dentist
  • Beaver Dam, WI
  • NPI 1629362017
  NPD (past) Authorized official
• Mark A Barrette, DDS

  • General Practice Dentistry
  • Beaver Dam, WI
  • NPI 1154480655
  NPD (past)

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377216000000",
    "number": "1245280742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 N. SPRING ST.",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "53916",
            "telephone_number": "920-885-6066",
            "fax_number": "920-885-6192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 N. SPRING STREET",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "53916",
            "telephone_number": "920-885-6066",
            "fax_number": "920-885-6192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARSEN FAMILY DENTAL S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2013-08-23",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-885-6066",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "500159515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mark Barrette DDS, S.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• John E Lambert, DO
• Holly Landry, DPT
• Taylor Christian Lang, PHARMD
• Amy Lanphier, COTA
• Trey Elliot Larant, DPT
• Andrea Kay Larsen, DDS
• Paul Larson, DPT
• Bryan Hartland Lassner, M.D.
• Jessica Marie Lawrence
• Mike Leahan, RPH

• Dentist in Beaver Dam, WI
• Providers in Beaver Dam, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2013; 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.