Mark Anthony Larusso, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

0401411249 Issued in VA

Practice address

1647 Taussig Boulevard
Naval Dental Clinic Norfolk
Norfolk, VA 23511-2896

Phone

(757) 953-8698

NPI assigned

Sep 30, 2005

Last updated

Sep 5, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

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

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188950400000",
    "number": "1558358960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 LEEWAY CT",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234551699",
            "telephone_number": "757-363-0321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1647 TAUSSIG BOULEVARD",
            "address_2": "NAVAL DENTAL CLINIC NORFOLK",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235112896",
            "telephone_number": "757-953-8698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARUSSO",
        "first_name": "MARK",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2007-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VA",
            "license": "0401411249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larkspur Wellness, PLLC
• Anthony Larocco Jr., M.D.
• Jeffery Brougham Larsen, DMD
• Jeanette Pueschel Larson, MD
• Kindra Anne Larson, MD
• Ladonia D Lassiter, CPHT
• Lynn Rushing Lassiter, PT, DPT, CIMT
• Julia Louise Lasswell, MD
• Emily Faye Latimer
• Kelly Maya Latimer, MD

• Oral and Maxillofacial Surgery (Dentist) in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2007; 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.