Active NPI
Robert Bruce Larsen, DDS
- General Practice Dentistry
- Lackland a F B, TX
National Provider Identifier
1770647307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 105092
- Practice address
- 1615 Truemper St
Lackland a F B, TX 78236-5511 - Phone
- (210) 292-6335
- Fax
- (210) 292-2740
- NPI assigned
- Dec 20, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 105092 | CO | Primary |
Addresses
Primary practice location
1615 Truemper St
Lackland a F B, TX 78236-5511
Mailing address
18839 Agin CT
San Antonio, TX 78258-4481
Phone (210) 479-1851
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 |
|---|---|---|---|
| 105092 | CO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1770647307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18839 AGIN CT",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782584481",
"telephone_number": "210-479-1851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1615 TRUEMPER ST",
"city": "LACKLAND A F B",
"state": "TX",
"postal_code": "782365511",
"telephone_number": "210-292-6335",
"fax_number": "210-292-2740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "ROBERT",
"middle_name": "BRUCE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "105092",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lackland a F B, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.