Active NPI
Donald E Larson DMD PC
- General Practice Dentistry
- Eagle, ID
National Provider Identifier
1417055062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D3551
- Legal business name
- DONALD E LARSON DMD PC
- Practice address
- 700 E State St
Suite 100
Eagle, ID 83616 - Phone
- (208) 939-3500
- Fax
- (208) 939-3837
- NPI assigned
- Sep 20, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Donald E Larson, DMD
- Title
- President
- Phone
- (208) 939-1570
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D3551 | ID | Primary |
Addresses
Primary practice location
700 E State St
Suite 100
Eagle, ID 83616
Mailing address
5919 N Lilybrook PL
Boise, ID 83713
Phone (208) 939-1570
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8061442 | Medicaid | ID | |
| CS9245 | Other | ID | ID STATE BOARD OF PHARM |
National Provider Directory
National Provider DirectoryLocations
700 E State St
#100
Eagle, ID 83616
Phone (208) 939-3500
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- General Practice Dentistry
- Eagle, ID
- NPI 1235435744
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1417055062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5919 N LILYBROOK PL",
"city": "BOISE",
"state": "ID",
"postal_code": "83713",
"telephone_number": "208-939-1570",
"fax_number": "208-939-1570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 E STATE ST",
"address_2": "SUITE 100",
"city": "EAGLE",
"state": "ID",
"postal_code": "83616",
"telephone_number": "208-939-3500",
"fax_number": "208-939-3837"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DONALD E LARSON DMD PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-20",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "LARSON",
"authorized_official_first_name": "DONALD",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "208-939-1570",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DMD"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "ID",
"license": "D3551",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8061442",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ID STATE BOARD OF PHARM",
"identifier": "CS9245",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.