Provider Demographics
NPI:1336770528
Name:CRAIG G. LARSON, DDS PLLC
Entity type:Organization
Organization Name:CRAIG G. LARSON, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-678-7232
Mailing Address - Street 1:2051 TERRY ST STE F
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1872
Mailing Address - Country:US
Mailing Address - Phone:303-678-7232
Mailing Address - Fax:303-678-7043
Practice Address - Street 1:2051 TERRY ST STE F
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1872
Practice Address - Country:US
Practice Address - Phone:303-678-7232
Practice Address - Fax:303-678-7043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental