Craig C. Larson
Individual provider Active NPI General Practice Dentistry · North Ogden, UT
NPI 1588782890 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1588782890
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 1420169 (UT)
- Practice address
- 2707 N 400 E
North Ogden, UT 84414-2241 - Phone
- (801) 782-0866
- Fax
- (801) 782-1344
- NPI assigned
- Mar 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1420169 | UT | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ben Lomond Dental LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1420169 | UT | Yes |
Addresses
Primary practice location
2707 N 400 E
North Ogden, UT 84414-2241
Mailing address
2707 N 400 E
North Ogden, UT 84414-2241
Phone (801) 782-0866
Other providers in North Ogden, UT
- Chad Ryan Jensen
- Crystal Jensen
- Philip Jiricko
- Jlsco LLC
- Jami D Lang
- Wade E. Larson
- Eric Daniels Linsley
- Kent O. Linsley
- Kathleen M Lofley
- Katie Lott
All providers in North Ogden, UT · General Practice Dentistry in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.