Provider Demographics
NPI:1215291802
Name:LARSON, CINDY LEE (RDH)
Entity type:Individual
Prefix:MS
First Name:CINDY
Middle Name:LEE
Last Name:LARSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15926 VILLAGE GREEN DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-4836
Mailing Address - Country:US
Mailing Address - Phone:425-422-4982
Mailing Address - Fax:
Practice Address - Street 1:15926 VILLAGE GREEN DR UNIT B
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-4836
Practice Address - Country:US
Practice Address - Phone:425-422-4982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00001597124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist