| Larsen Family Dentistry, P.c. | |
|
3103 W Big Trail Dr Jackson WY 83001-9296 | |
| (307) 733-4778 | |
| (307) 734-8041 |
| Full Name | Larsen Family Dentistry, P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3103 W Big Trail Dr, Jackson, Wyoming |
| Authorized Official Name and Position | Scott Coburn Larsen (DENTIST) |
| Authorized Official Contact | 3077334778 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Larsen Family Dentistry, P.c. Po Box 4935 Jackson WY 83001-4935 Ph: (307) 733-4778 | Larsen Family Dentistry, P.c. 3103 W Big Trail Dr Jackson WY 83001-9296 Ph: (307) 733-4778 |
| NPI Number | 1205010287 |
|---|---|
| Provider Enumeration Date | 12/26/2007 |
| Last Update Date | 11/28/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205010287 | NPI | - | NPPES |
| 118068100 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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