Provider Demographics
NPI:1861634909
Name:LARSEN, STEVEN SCOTT (DDS MS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:SCOTT
Last Name:LARSEN
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E 200 N
Mailing Address - Street 2:STE G
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6602
Mailing Address - Country:US
Mailing Address - Phone:435-753-7668
Mailing Address - Fax:435-755-9815
Practice Address - Street 1:150 E 200 N
Practice Address - Street 2:STE G
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6602
Practice Address - Country:US
Practice Address - Phone:435-753-7668
Practice Address - Fax:435-755-9815
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT09-006351223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics