Andrea Kay Larsen, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

6701-15 Issued in WI

Practice address

210 Madison St
Beaver Dam, WI 53916-2310

Phone

(920) 885-6066

NPI assigned

Jun 3, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Larsen Family Dental S.C.

  • Dentist
  • Beaver Dam, WI
  • NPI 1245280742
  NPD (past) Authorized official

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

{
    "created_epoch": "1307059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1629362017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 MADISON ST",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162310",
            "telephone_number": "920-885-6066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 MADISON ST",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162310",
            "telephone_number": "920-885-6066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "ANDREA",
        "middle_name": "KAY",
        "name_prefix": "Mrs.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-03",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6701-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Landry, DPT
• Taylor Christian Lang, PHARMD
• Amy Lanphier, COTA
• Trey Elliot Larant, DPT
• Larsen Family Dental S.C.
• Paul Larson, DPT
• Bryan Hartland Lassner, M.D.
• Jessica Marie Lawrence
• Mike Leahan, RPH
• Hannah E Lein, SAC-IT

• Dentist in Beaver Dam, WI
• Providers in Beaver Dam, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; 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.