Larissa Gushansky Dds, Inc. | |
3175 Firestone Blvd Suite200 South Gate CA 90280-2951 | |
(323) 563-9124 | |
(323) 563-9814 |
Full Name | Larissa Gushansky Dds, Inc. |
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Speciality | Dentist |
Location | 3175 Firestone Blvd, South Gate, California |
Authorized Official Name and Position | Larissa Gushansky (PRESIDENT) |
Authorized Official Contact | 3235639124 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Larissa Gushansky Dds, Inc. 3175 Firestone Blvd Suite200 South Gate CA 90280-2951 Ph: (323) 563-9124 | Larissa Gushansky Dds, Inc. 3175 Firestone Blvd Suite200 South Gate CA 90280-2951 Ph: (323) 563-9124 |
NPI Number | 1831383140 |
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Provider Enumeration Date | 08/29/2007 |
Last Update Date | 08/29/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1831383140 | NPI | - | NPPES |
B36156-01 | Other | CA | DENTI-CAL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 36156 (California) | Primary |
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