Jennifer Sue Larson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901019425 Issued in MI

Practice address

216 N Lake St
Boyne City, MI 49712-1210

Phone

(231) 582-4480

Fax

(231) 582-4460

NPI assigned

Nov 1, 2006

Last updated

Jul 6, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Park View Family Dentistry

  • Dentist
  • Boyne City, MI
  • NPI 1104256387
  NPD Authorized official

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593993600000",
    "number": "1629156500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 N LAKE ST",
            "city": "BOYNE CITY",
            "state": "MI",
            "postal_code": "497121210",
            "telephone_number": "231-350-6747",
            "fax_number": "231-582-4460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 N LAKE ST",
            "city": "BOYNE CITY",
            "state": "MI",
            "postal_code": "497121210",
            "telephone_number": "231-582-4480",
            "fax_number": "231-582-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "JENNIFER",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901019425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4916278",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MICHIGAN BOARD OF DENTISTRY",
            "identifier": "2901019425",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jaelyn Kay Jarema
• Laura Elizabeth Jeffries, LMSW
• Ally G Kennedy, DPT
• Dennis Edward Kirkby, DDS
• Pamela R Knysz, MD
• Sarah Ann Leist, LLPC
• Brittany M Lowry
• Leonhard J Maendel, P.A.
• Karen Marietti
• Max H Engelman

• Dentist in Boyne City, MI
• Providers in Boyne City, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 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.