Provider Demographics
NPI:1699539635
Name:LARSEN, SETH ALAN
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:ALAN
Last Name:LARSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AUGUSTA UNIVERSITY, THE DENTAL COLLEGE OF GEORGIA
Mailing Address - Street 2:1120 15TH STREET, GC 5114
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AUGUSTA UNIVERSITY, THE DENTAL COLLEGE OF GEORGIA
Practice Address - Street 2:1120 15TH STREET, GC 5114
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912
Practice Address - Country:US
Practice Address - Phone:706-721-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program