Scott Joseph Larson, D.D.S
Individual provider Active NPI General Practice Dentistry · Blackduck, MN
NPI 1952467466 · NPPES record last updated Oct 25, 2012
Key facts
- NPI
- 1952467466
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D12251 (MN)
- Practice address
- 49 Summit Ave. E.
Blackduck, MN 56630-9727 - Phone
- (218) 835-4227
- NPI assigned
- Dec 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D12251 | MN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blackduck Dental Clinic PSC | General Practice | Past | Accepting new patients |
| Blackduck Dental Clinic | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D12251 | MN | Yes |
Addresses
Primary practice location
49 Summit Ave. E.
Blackduck, MN 56630-9727
Mailing address
PO Box 308
Blackduck, MN 56630-0308
Phone (218) 835-4227
Other providers in Blackduck, MN
- Blackduck Isd #32
- Deborah Dilley
- Michelle Furuseth
- Jenna Gross
- Elaine D Kelly
- Moon'S Pharmacy
- Colleen Notsch
- Thomas K O'Reilly
- Sanford Clinic North
- Sanford Health of Northern Minnesota
All providers in Blackduck, MN · General Practice Dentistry in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.