Individual
DR. ERIC A. LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
928 E 100 S, STE #B, SALT LAKE CITY, UT 84102-1455
(801) 355-4733
(801) 322-0629
Mailing address
928 EAST 100 SOUTH, STE #B, SALT LAKE CITY, UT 84102-8410
(801) 355-4733
(801) 322-0629
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
334445-9921
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80012476
TIN #
UT
Enumeration date
03/15/2007
Last updated
07/08/2007
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