Bradley Larsen, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00005129 Issued in WA

Practice address

148 Division Ave
Morton, WA 98356-9300

Phone

(360) 496-5101

Fax

(360) 496-4123

NPI assigned

Jul 24, 2006

Last updated

Feb 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1760404164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2114 MAIN ST STE 100-140",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986602674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 DIVISION AVE",
            "city": "MORTON",
            "state": "WA",
            "postal_code": "983569300",
            "telephone_number": "360-496-5101",
            "fax_number": "360-496-4123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "BRADLEY",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00005129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Jean Hemenway, L.D.
• John R Hines, D.O.
• Karyl Desneiges Huber, DN
• Kindra R Keys, LMP
• Denise Klempay, LMT
• Lewis County Community Health Services (Valley View Health Center)
• Lewis County FPD 4
• Lewis County Hospital Dist #1
• Lewis County Hospital District No 1 (Arbor Health Morton Hospital)
• Lewis County Hospital District No. 1 (Arbor Health)

• General Practice Dentistry in Morton, WA
• Providers in Morton, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.