# PARK VIEW FAMILY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104256387
- **Authorized official:** DR. JENNIFER SUE LARSON DDS (PRESIDENT / OWNER)
- **Authorized official phone:** (231) 350-6747

## Contact information

- **Practice address:** 202 N LAKE ST, BOYNE CITY, MI 49712-1210
- **Practice address phone:** (231) 582-4480
- **Practice address fax:** (231) 582-4460
- **Mailing address:** 202 N LAKE ST, BOYNE CITY, MI 49712-1210
- **Mailing address phone:** (231) 582-4480
- **Mailing address fax:** (231) 582-4460

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 22901019425 | MI | Yes |

## Other

- **Enumeration date:** 11/25/2013
- **Last updated:** 11/25/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2901019425 | STATE DENTAL LICENSE | MI |