Provider Demographics
NPI:1316151145
Name:LARSON, JAN H (DDS)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:H
Last Name:LARSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 CASTLETON WAY
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1301
Mailing Address - Country:US
Mailing Address - Phone:740-363-1306
Mailing Address - Fax:740-363-0050
Practice Address - Street 1:1816 CASTLETON WAY
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1301
Practice Address - Country:US
Practice Address - Phone:740-363-1306
Practice Address - Fax:740-363-0050
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0139131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice