Joseph Robert Larson, DMD, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2901021920 Issued in MI

Practice address

6207 Harvey St Ste a
Norton Shores, MI 49444-7861

Phone

(231) 690-9083

NPI assigned

May 31, 2016

Last updated

Jun 27, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

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

Credentials

Doctor of Medicine

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.

• Breakwater Oral and Maxillofacial Surgery PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Norton Shores, MI
  • NPI 1487375218
  Medicare reassignment NPD
• Breakwater Oral and Maxillofacial Surgery PLLC

  dba Great Oaks Periodontics & Dental Implants

  • Periodontics
  • Rochester, MI
  • NPI 1114856226
  NPD

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

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656288000000",
    "number": "1710335872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6207 HARVEY ST STE A",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494447861",
            "telephone_number": "231-690-9083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6207 HARVEY ST STE A",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494447861",
            "telephone_number": "231-690-9083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "JOSEPH",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DMD, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-31",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901021920",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901021920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laketown Family Dental, PLLC (Laketown Family Dental)
• Ivan R Landan, M.D.
• Rachael Nicole Lane, DO
• Marissa F Lange
• Erlund John Larson, PHD.,MD
• Carolyn Lawless, DPT
• Elizabeth Lawrence, AT, ATC
• Sean M Lawson, MD
• Jennifer J Layne-Roy
• John Michael Leclaire, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Norton Shores, MI
• Providers in Norton Shores, MI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.