Organization
DONALD E LARSON DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD E LARSON DMD (PRESIDENT)
(208) 939-1570
Entity
Organization
Contact information
Practice address
700 E STATE ST, SUITE 100, EAGLE, ID 83616
(208) 939-3500
(208) 939-3837
Mailing address
5919 N LILYBROOK PL, BOISE, ID 83713
(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
05
—
8061442
—
ID
01
—
CS9245
ID STATE BOARD OF PHARM
ID
Enumeration date
09/20/2006
Last updated
08/22/2020
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