GREGG STUART LARSON (NPI# 1780625772) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780625772 |
| Entity Type | Individual |
| Full Name | GREGG STUART LARSON |
| Credential | DDS |
| Practice Address |
1900 Centracare Circle Ste 0350 St Cloud MN 56303-5000 |
| Practice Telephone | 3202530272 |
| Practice Fax Number | 3202512661 |
| Mailing Telephone | 3202530272 |
| Mailing Fax Number | 3202512661 |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2014-10-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
11344 | MN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BLUE CROSS BLUE SHIELD | 294L9LA | 01 |
| MN | 286909800 | 05 | |
| MN | HEALTH PARTNERS | HP37202 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972671071 | Gregg A Larson | Dentist | 2716 Upper Afton Road, Saint Paul, MN 55119-4780 | 2006-11-30 |
| Street Address |
1900 CENTRACARE CIRCLE STE 0350 |
| City | ST CLOUD |
| State | MN |
| Zip Code | 56303-5000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003815051 | Jennifer J Rogan | Pediatrics | 1900 Centracare Circle, Centracare Clinic Womens & Childrens, St Cloud, MN 56303 | 2005-07-20 |
| 1659694628 | Bethany T. Dingmann | Dietitian, Registered | 1900 Centracare Circle, Suite 2500, St Cloud, MN 56303-5000 | 2010-03-05 |
| 1073708608 | Rachel Wenner Ruzanic | Dermatology | 1900 Centracare Circle, Centracare Clinic- Health Plaza Specialties, St Cloud, MN 56303-5000 | 2007-09-06 |
| 1982737938 | Daniel W Kraft | Internal Medicine | 1900 Centracare Circle, Centracare Clinic Health Plaza Gastroenterology, St Cloud, MN 56303 | 2007-03-13 |
| 1154466209 | Robin C Marushin | Obstetrics & Gynecology | 1900 Centracare Circle, Centracare Clinic Womens & Childrens, St Cloud, MN 56303 | 2007-02-20 |
| 1124173919 | David M Pence | Radiology | 1900 Centracare Circle, St Cloud, MN 56303 | 2007-01-24 |
| 1659425114 | Centracare Clinic | Durable Medical Equipment & Medical Supplies | 1900 Centracare Circle, Centracare Clinic Internal Medicine, St Cloud, MN 56303 | 2007-01-22 |
| 1720155336 | Nelson L Adamson | Radiology | 1900 Centracare Circle, Centracare Clinic Health Plaza Specialties, St Cloud, MN 56303-5000 | 2006-11-29 |
| 1588734214 | Erin Y Scapanski | Physician Assistant | 1900 Centracare Circle, Centracare Clinic, St Cloud, MN 56303 | 2006-11-09 |
| 1639248065 | Donna F Johnson | Psychologist | 1900 Centracare Circle, Centracare Health Plaza, St Cloud, MN 56303 | 2006-11-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720028624 | Joseph Hall Wenner | Dentist | 1900 Centracare Circle, Ste 0350, St Cloud, MN 56303-5000 | 2006-06-08 |
| 1629018536 | Michael Waldemar Steil | Dentist | 1900 Centracare Circle, Ste 0350, St Cloud, MN 56303-5000 | 2006-06-08 |
| 1144267063 | Central Mn Pediatric Dentists Pa | Dentist | 1900 Centracare Circle, Ste 0350, St Cloud, MN 56303-5000 | 2006-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477025906 | Riverdale Kidds Pediatric Dentistry, Pllc | Dentist | 3585 124th Ave Nw Ste 400, Coon Rapids, MN 55433-1008 | 2018-12-21 |
| 1467924290 | Camp Smile Pediatric Dentistry Excelsior Pllc | Dentist | 675 Water St Ste 2, Excelsior, MN 55331-3072 | 2018-12-18 |
| 1932671765 | Camp Smile Pediatric Dentistry Chaska | Dentist | 111 Hundertmark Rd Ste 304n, Chaska, MN 55318-1587 | 2018-12-18 |
| 1538678057 | Blaine Kidds Pediatric Dentistry Pllc | Dentist | 1351 113th Ave Ne, Blaine, MN 55434-3874 | 2017-09-27 |
| 1760918239 | David James Knight | Dentist | 9950 Valley Creek Rd Ste 150, Woodbury, MN 55125 | 2017-05-03 |
| 1710367925 | Lindsay Bedeaux | Dentist | 7373 France Ave S Ste 400, Edina, MN 55435-4549 | 2015-06-02 |
| 1609272822 | Rochester Pediatric Dentistry LLC | Dentist | 1705 S Boradway Ave Ste B, Rochester, MN 55904-7960 | 2014-11-16 |
| 1396186813 | Central Minnesota Pediatric Dentists Pa | Dentist | 507 N Nokomis St Ste C, Alexandria, MN 56308-2353 | 2013-07-12 |
| 1265873707 | Central Minnesota Pediatric Dentists Pa | Dentist | 570 Humboldt Dr Ste 102, Big Lake, MN 55309-4844 | 2013-07-12 |
| 1013264621 | Northland Dental Partners | Dentist | 3507 Round Lake Blvd. Suite 900, Anoka, MN 55303 | 2012-08-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.