Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 010067 | CT |
Y | 122300000X | Dentist | 055413 | NY |
N | 1223P0221X | Pediatric Dentist | 055413 | NY |
NPI | 1023247640 |
---|---|
Provider Name | Dr. Natasha A Larson |
First Address | West Hartford, CT 06119-1630 |
Second Address | Farmington, CT 06030-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2009 |
Last Update Date | 18/03/2011 |