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Organization
LARISSA GUSHANSKY, DDS INC.
Active
Organization
LARISSA GUSHANSKY, DDS INC.
Active
Other names
State Dental Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARISSA GUSHANSKY DDS (OWNER)
(323) 563-9124
Entity
Organization
Contact information
Practice address
3175 FIRESTONE BLVD STE 200, SOUTH GATE, CA 90280-2951
(323) 563-9124
(323) 563-9814
Mailing address
3175 FIRESTONE BLVD STE 200, SOUTH GATE, CA 90280-2951
(323) 563-9124
(323) 563-9814
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/07/2007
Last updated
11/30/2021
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