| Larsen Dental Care | |
|
950 Hospital Way Suite B Pocatello ID 83201-2789 | |
| (208) 233-7007 | |
| (208) 233-2512 |
| Full Name | Larsen Dental Care |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 950 Hospital Way, Pocatello, Idaho |
| Authorized Official Name and Position | Bryce R Larsen (DENTIST OWNER) |
| Authorized Official Contact | 2082337007 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Larsen Dental Care 950 Hospital Way Suite B Pocatello ID 83201-2789 Ph: (208) 233-7007 | Larsen Dental Care 950 Hospital Way Suite B Pocatello ID 83201-2789 Ph: (208) 233-7007 |
| NPI Number | 1104061449 |
|---|---|
| Provider Enumeration Date | 12/15/2008 |
| Last Update Date | 12/15/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104061449 | NPI | - | NPPES |
| 8072105 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D-3894 (Idaho) | Primary |
| 1223G0001X | Dentist - General Practice | D-1599 (Idaho) | Secondary |
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