Active NPI
Gregg A Larson, DDS
- Dentist
- Saint Paul, MN
National Provider Identifier
1972671071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7974
- Practice address
- 2716 Upper Afton Road
Saint Paul, MN 55119-4780 - Phone
- (651) 739-5110
- Fax
- (651) 739-1873
- NPI assigned
- Nov 30, 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 7974 | MN | Primary |
Addresses
Primary practice location
2716 Upper Afton Road
Saint Paul, MN 55119-4780
Mailing address
2716 Upper Afton Road
Saint Paul, MN 55119-4780
Phone (651) 739-5110
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 660715200 | Medicaid | MN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7974 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972671071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2716 UPPER AFTON ROAD",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551194780",
"telephone_number": "651-739-5110",
"fax_number": "651-739-1873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2716 UPPER AFTON ROAD",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551194780",
"telephone_number": "651-739-5110",
"fax_number": "651-739-1873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "GREGG",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "7974",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "660715200",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
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.