Kristopher Bryce Larson, DMD
Dentist in Mesa, AZ. Individual provider (NPI-1).
NPI number1114396751
StatusActive
Last updated in NPPESDec 22, 2016
Details
- NPI
- 1114396751
- Entity type
- Individual (NPI-1)
- Name
- Kristopher Bryce Larson
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 23, 2015
- Last updated
- Dec 22, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | D009505 | AZ | Yes |
| 122300000X | Dentist | DEN.00202672 | CO |
Practice location
4050 E Huber StMesa, AZ 85205-4022
Phone 801-921-0792
Mailing address
4050 E Huber StMesa, AZ 85205-4022
Phone 801-921-0792
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