Ivan M Larsen, D.M.D

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

2019008323 Issued in MO

Practice address

1002 Diamond RDG Ste 1500
Jefferson City, MO 65109-7914

Phone

(573) 298-4400

NPI assigned

Oct 24, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

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

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.

• Missouri Dental Specialists

  • Endodontics
  • Jefferson City, MO
  • NPI 1518427079
  NPD (past)

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

{
    "created_epoch": "1477267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1285185355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 DIAMOND RDG STE 1500",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651097914",
            "telephone_number": "573-298-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 DIAMOND RDG STE 1500",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651097914",
            "telephone_number": "573-298-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1311 E Central Dr",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836427991",
            "country_code": "US",
            "telephone_number": "208-373-1860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "IVAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-24",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-4797",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2019008323",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MO",
            "license": "2019008323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Lange, MD
• Devin Langendoerfer, LCSW
• Lacey Lansford, FNP-BC
• Neal Gerard Lapointe, D.O.
• Joselito C Lariosa, PT
• Jordan Larsen, LCSW
• Phyllis Larson, LPC
• Justin Lauf
• Aaron Joseph Laughlin, DO
• Katelyn Laughlin

• Endodontics in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Endodontics in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; 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.