Individual
KYLE LUIS LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
928 SMITH AVE, TRINIDAD, CO 81082-2841
(719) 422-8810
Mailing address
928 SMITH AVE, TRINIDAD, CO 81082-2841
(719) 422-8810
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DEN.00203245
CO
Other
Enumeration date
07/11/2017
Last updated
10/28/2020
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