Jeffry James Larson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D10673 Issued in MN

Practice address

19TH Medical Group 1090 Arnold Drive
Little Rock AFB, AR 72099-0001

Phone

(501) 987-7304

NPI assigned

Aug 22, 2005

Last updated

Dec 3, 2020By 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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1811989270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19TH MEDICAL GROUP 1090 ARNOLD DRIVE",
            "city": "LITTLE ROCK AFB",
            "state": "AR",
            "postal_code": "720990001",
            "telephone_number": "501-987-7304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19TH MEDICAL GROUP 1090 ARNOLD DRIVE",
            "city": "LITTLE ROCK AFB",
            "state": "AR",
            "postal_code": "720990001",
            "telephone_number": "501-987-7304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "JEFFRY",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D10673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa A Kennedy, LCSW
• Brittany Elaine King, NP
• Allan Kipngeno
• Rhonda M Kraft
• Angela Brooke Lane, PSY.D.
• Marybeth S. Lenz, NP
• Alexander Brian Gutierrez Marquez, MD
• Kayleigh A Marsolini, DPT
• Sonja Renee Collier Martin, PA-C
• Tracie Arlene Martin, LCSW

• General Practice Dentistry in Little Rock AFB, AR
• Providers in Little Rock AFB, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; 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.