Active NPI
Bennett Packard Larsen, DDS
- Dentist
- Tacoma, WA
National Provider Identifier
1255772109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE60384483
- Practice address
- 223 140TH St S
Suite 800
Tacoma, WA 98444-4531 - Phone
- (253) 537-1559
- Fax
- (253) 536-5907
- NPI assigned
- Jul 8, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE60384483 | WA | Primary |
Addresses
Primary practice location
223 140TH St S
Suite 800
Tacoma, WA 98444-4531
Mailing address
223 140TH St S
Suite 800
Tacoma, WA 98444-4531
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE60384483 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373241600000",
"number": "1255772109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "223 140TH ST S",
"address_2": "SUITE 800",
"city": "TACOMA",
"state": "WA",
"postal_code": "984444531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "223 140TH ST S",
"address_2": "SUITE 800",
"city": "TACOMA",
"state": "WA",
"postal_code": "984444531",
"telephone_number": "253-537-1559",
"fax_number": "253-536-5907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "BENNETT",
"middle_name": "PACKARD",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-07-08",
"last_updated": "2013-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE60384483",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.