| Organization Name: | W.BRENT LARSEN, D.D.S., P.A. |
| NPI Number: | 1053591495 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | W. BRENT LARSEN (OWNER) |
| Mailing Address: | 3 Templeton Dr Cabot |
| State: | AR US |
| Postal Code: | 720233821 |
| Phone Number: | 5018439306 |
| Fax Number: | 5018434251 |
| NPI Enumeration Date: | 11/13/2007 |
| NPI Last Update Date: | 11/13/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 2976 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |