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Provider Information for 1669874863

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

KIRK LARSON DDS

Gender: MALE

Individual NPI: 1669874863

Calendar   Last Updated:  2014-09-18
  Certification Date: 

Details

Name Value
NPI 1669874863
Enumeration Date 2014-09-18
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 3261 N HARBOR BLVD SUITE A
FULLERTON, CA 92835-1740
United States

Phone: 714-870-9445 | Fax: 714-870-9460
View Map External Link
Primary Practice Address 3261 N HARBOR BLVD SUITE A
FULLERTON, CA 92835-1740
United States

Phone: 714-870-9445 | Fax: 714-870-9460
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist CA 36388