Kyle Luis Larsen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEN.00203245 Issued in CO

Practice address

928 Smith Ave
Trinidad, CO 81082-2841

Phone

(719) 422-8810

NPI assigned

Jul 11, 2017

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 CO

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

Locations

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.

• Salud Family Health

  • Federally Qualified Health Center (FQHC)
  • Fort Lupton, CO
  • NPI 1275530388
  Medicare reassignment NPD
• Salud Family Health

  • Federally Qualified Health Center (FQHC)
  • Aurora, CO
  • NPI 1134766553
  NPD
• Salud Family Health

  • Federally Qualified Health Center (FQHC)
  • Fort Morgan, CO
  • NPI 1740947407
  NPD

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

{
    "created_epoch": "1499731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1386166304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "928 SMITH AVE",
            "city": "TRINIDAD",
            "state": "CO",
            "postal_code": "810822841",
            "telephone_number": "719-422-8810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "928 SMITH AVE",
            "city": "TRINIDAD",
            "state": "CO",
            "postal_code": "810822841",
            "telephone_number": "719-422-8810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "KYLE",
        "middle_name": "LUIS",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-11",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "DEN.00203245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Karls
• Parker Theodore Kastelic I, DMD
• Kandra Selby Kendall, DPT, PT
• Ashleigh Nichole King, PARAMEDICAL TATTOO
• KRV Counseling LLC
• Beverly Larson
• Teresa Larson, DIETITIAN
• Las Animas County Department of Social Services
• Las Animas County Department of Social Services
• Las Animas County Rehabilitation Center

• General Practice Dentistry in Trinidad, CO
• Providers in Trinidad, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; 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.