# LARSEN FAMILY DENTISTRY, P.C.

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

## Provider details

- **NPI number:** 1205010287
- **Authorized official:** DR. SCOTT COBURN LARSEN DMD (DENTIST)
- **Authorized official phone:** (307) 733-4778

## Contact information

- **Practice address:** 3103 W BIG TRAIL DR, JACKSON, WY 83001-9296
- **Practice address phone:** (307) 733-4778
- **Practice address fax:** (307) 734-8041
- **Mailing address:** PO BOX 4935, JACKSON, WY 83001-4935
- **Mailing address phone:** (307) 733-4778
- **Mailing address fax:** (307) 734-8041

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/26/2007
- **Last updated:** 11/28/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 118068100 | — | WY |