Active NPI
Dana Diane Larson, DDS
- General Practice Dentistry
- Olympia, WA
National Provider Identifier
1861608564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 7455
- Practice address
- 1212 E 4TH Ave
Olympia, WA 98506 - Phone
- (360) 357-6220
- Fax
- (360) 352-5412
- NPI assigned
- May 16, 2007
- Sex
- Female
- 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 | 7455 | WA | Primary |
Addresses
Primary practice location
1212 E 4TH Ave
Olympia, WA 98506
Mailing address
1212 E 4TH Ave
Olympia, WA 98506
Phone (360) 357-6220
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 831896 | Other | WA | UNITED CONCORDIA |
| 5356001 | Other | WA | DSHS |
| 9590 | Other | WA | WASHINGTON DENTAL SERVICE |
| 134017 | Other | WA | L AND I |
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 |
|---|---|---|---|
| 7455 | WA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861608564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1212 E 4TH AVE",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "98506",
"telephone_number": "360-357-6220",
"fax_number": "360-352-5412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 E 4TH AVE",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "98506",
"telephone_number": "360-357-6220",
"fax_number": "360-352-5412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "DANA",
"middle_name": "DIANE",
"name_prefix": "Ms.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "7455",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "831896",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DSHS",
"identifier": "5356001",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WASHINGTON DENTAL SERVICE",
"identifier": "9590",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L AND I",
"identifier": "134017",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
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.