Individual
SAMUEL LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4403 MARLBOROUGH AVE, SAN DIEGO, CA 92116-4727
(952) 486-9759
Mailing address
5225 50TH AVE NE UNIT 207, SEATTLE, WA 98105-2872
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
112429
CA
126800000X
Dental Assistant
Primary
D160946710
WA
Other
Enumeration date
07/02/2020
Last updated
02/06/2026
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