Provider Demographics
NPI:1316687437
Name:ADACARE DENTAL & DENTURES PLLC
Entity type:Organization
Organization Name:ADACARE DENTAL & DENTURES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-996-5808
Mailing Address - Street 1:3909 E FAIRVIEW AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5814
Mailing Address - Country:US
Mailing Address - Phone:208-996-5808
Mailing Address - Fax:208-996-7208
Practice Address - Street 1:3909 E FAIRVIEW AVE STE 150
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5814
Practice Address - Country:US
Practice Address - Phone:208-996-5808
Practice Address - Fax:208-996-7208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty