Individual
DR. MATTHEW BRENT LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
928 E 100 S, SUITE A, SALT LAKE CITY, UT 84102-1455
(801) 860-5010
Mailing address
928 E 100 S, SUITE A, SALT LAKE CITY, UT 84102-1455
(801) 860-5010
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7362558-9922
UT
1223G0001X
General Practice Dentistry
7362558-9922
UT
Other
Enumeration date
06/25/2009
Last updated
04/21/2010
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