Individual
DONALD E LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
700 E STATE ST STE 100, EAGLE, ID 83616-5941
(208) 939-3500
(208) 939-9897
Mailing address
5919 N LILYBROOK PL, BOISE, ID 83713-1381
(208) 939-1570
(208) 939-1570
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3551
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1312746
UNITED CONCORDIA
ID
05
—
8061442
—
ID
01
—
CS9245
ID STATE BOARD OF PHARMACY
ID
Enumeration date
01/31/2011
Last updated
01/31/2011
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