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Organization
LARISSA GUSHANSKY, DDS INC.
Active
Organization
LARISSA GUSHANSKY, DDS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARISSA GUSHANSKY (PRESIDENT)
(323) 563-9124
Entity
Organization
Contact information
Practice address
887 E 2ND ST, SUITE B, POMONA, CA 91766-2009
(909) 865-8595
Mailing address
887 E 2ND ST, SUITE B, POMONA, CA 91766-2009
(909) 865-8595
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
36156
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B36156-02
DENTI-CAL
CA
Enumeration date
09/04/2007
Last updated
09/04/2007
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