Larsen, Bryce Robert

Larsen, Bryce Robert is an individual health care provider with primary practice located at 950 Hospital Way Suite B, Pocatello ID 83201-2789. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Larsen, Bryce Robert can be contacted via phone (208) 233-7007.

Contact Information

Primary practice address
950 Hospital Way Suite B Pocatello ID 83201-2789
Phone: (208) 233-7007
Fax: (208) 233-2512
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X D3894 Idaho

Profile Details

NPI number 1821210535
LBN Legal business name Larsen, Bryce Robert
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 3rd, 2007
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821210535 NPPES
Idaho MEDICAID 8072105

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