Provider Demographics
NPI:1689779282
Name:LARSCHEID, DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:LARSCHEID
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11086 ABERDEEN STREET NE
Mailing Address - Street 2:150
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449
Mailing Address - Country:US
Mailing Address - Phone:763-786-1545
Mailing Address - Fax:763-786-2939
Practice Address - Street 1:11806 ABERDEEN ST NE
Practice Address - Street 2:150
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4736
Practice Address - Country:US
Practice Address - Phone:763-786-1545
Practice Address - Fax:763-786-2939
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN114341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN717670800Medicaid