Active NPI
Dallin Larson, DDS
- Endodontics
- Meridian, ID
National Provider Identifier
1790288306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- D-5309-EN
- Practice address
- 3240 E Louise Dr
Meridian, ID 83642-5107 - Phone
- (208) 898-8866
- NPI assigned
- Mar 10, 2018
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | D-5309-EN | ID | Primary |
Addresses
Primary practice location
3240 E Louise Dr
Meridian, ID 83642-5107
Mailing address
2289 N Montgomery Ave
Meridian, ID 83646-8819
Phone (208) 859-4112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180801001223 | CT | Order and Referring Only - Dentist | 5496003881 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-5309-EN | ID | MD | Endodontist |
| 12539 | CT | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625097600000",
"number": "1790288306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2289 N MONTGOMERY AVE",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836468819",
"telephone_number": "208-859-4112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3240 E LOUISE DR",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836425107",
"telephone_number": "208-898-8866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "DALLIN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-03-10",
"last_updated": "2021-07-01",
"certification_date": "2021-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "ID",
"license": "D-5309-EN",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2021; 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.