Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | DEN-DEN-LIC-7687 | MT |
NPI | 1295986396 |
---|---|
Provider Name | Dr. Ryan Kent Larsen |
First Address | Billings, MT 59102-0001 |
Second Address | Billings, MT 59106-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2008 |
Last Update Date | 26/01/2019 |