Active NPI
Lewis Rodney Larsen
- Dentist
- Phoenix, AZ
National Provider Identifier
1760713994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1170
- Practice address
- 6831 S Central Ave
Phoenix, AZ 85042-5420 - Phone
- (602) 268-8881
- NPI assigned
- Jan 28, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1170 | AZ | Primary |
Addresses
Primary practice location
6831 S Central Ave
Phoenix, AZ 85042-5420
Mailing address
6831 South Central Ave
Phoenix, AZ 85042
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1170 | AZ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Central Dental LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Phoenix, AZ
- NPI 1952636573
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264636800000",
"number": "1760713994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6831 SOUTH CENTRAL AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "85042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6831 S CENTRAL AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850425420",
"telephone_number": "602-268-8881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "LEWIS",
"middle_name": "RODNEY",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-01-28",
"last_updated": "2010-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "1170",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.