Individual provider Active NPI

Steven J Larson, DDS

  • Dentist
  • Hayward, WI
National Provider Identifier
1629027040
Registry record updated Aug 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5001771015 Issued in WI
Practice address
15541 Highway 77 E
Hayward, WI 54843-6684
Phone
(715) 634-6776
Fax
(715) 634-5859
NPI assigned
May 10, 2006
Last updated
Aug 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 5001771015 WI Primary

Addresses

Primary practice location

15541 Highway 77 E
Hayward, WI 54843-6684

Mailing address

15541 Highway 77 E
Hayward, WI 54843-6684
Phone (715) 634-6776

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20151230000201 WI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 5991024473

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5001771015WIMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Dental Clinic of Marshfield SC Dentist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786579200000",
    "number": "1629027040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15541 HIGHWAY 77 E",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548436684",
            "telephone_number": "715-634-6776",
            "fax_number": "715-634-5859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15541 HIGHWAY 77 E",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548436684",
            "telephone_number": "715-634-6776",
            "fax_number": "715-634-5859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "STEVEN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-10",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "5001771015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hayward, WI

Sources for this page

Verify at the official NPI Registry.