NPIMap

Organization Active NPI

Larson Family Dentistry

  • Dental Clinic/Center
  • Prescott Valley, AZ
National Provider Identifier
1740655190
Registry record updated Dec 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
D04296 Issued in AZ
Legal business name
LARSON FAMILY DENTISTRY
Doing business as
Larson Dental
Practice address
8086 E Florentine Rd
Prescott Valley, AZ 86314-9422
Phone
(928) 772-8128
Fax
(928) 772-2369
NPI assigned
Dec 10, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2015

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

Authorized official

Name
Dr. Kelly J Larson, DDSNPI 1346310414
Title
Partner
Phone
(928) 772-8128

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X D04296 AZ Primary
Dental Clinic/Center 261QD0000X D008229 AZ

Addresses

Primary practice location

8086 E Florentine Rd
Prescott Valley, AZ 86314-9422

Mailing address

8086 E Florentine Rd
Prescott Valley, AZ 86314-9422
Phone (928) 772-8128

Other names 1

  • Larson Dental Doing business as

National Provider Directory

National Provider Directory

Locations

8086 E Florentine Rd
Prescott Valley, AZ 86314
Phone (928) 772-8128

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1449705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449705600000",
    "number": "1740655190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8086 E FLORENTINE RD",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863149422",
            "telephone_number": "928-772-8128",
            "fax_number": "928-772-2369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8086 E FLORENTINE RD",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863149422",
            "telephone_number": "928-772-8128",
            "fax_number": "928-772-2369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARSON FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-10",
        "last_updated": "2015-12-10",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "928-772-8128",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AZ",
            "license": "D04296",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "AZ",
            "license": "D008229",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Larson Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prescott Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.