| Larson Dental | |
|
8086 E Florentine Rd Prescott Valley AZ 86314-9422 | |
| (928) 772-8128 | |
| (928) 772-2369 |
| Full Name | Larson Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 8086 E Florentine Rd, Prescott Valley, Arizona |
| Authorized Official Name and Position | Kelly J Larson (PARTNER) |
| Authorized Official Contact | 9287728128 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Larson Dental 8086 E Florentine Rd Prescott Valley AZ 86314-9422 Ph: (928) 772-8128 | Larson Dental 8086 E Florentine Rd Prescott Valley AZ 86314-9422 Ph: (928) 772-8128 |
| NPI Number | 1740655190 |
|---|---|
| Provider Enumeration Date | 12/10/2015 |
| Last Update Date | 12/10/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740655190 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D04296 (Arizona) | Primary |
| 261QD0000X | Clinic/center - Dental | D008229 (Arizona) | Secondary |
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