# LAROSE DENTAL PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kootenai Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578815130
- **Authorized official:** ALEXIS LAROSE DDS (PRESIDENT/DENTIST)
- **Authorized official phone:** (208) 664-8283

## Contact information

- **Practice address:** 1420 LINCOLN WAY, SUITE 200, COEUR D ALENE, ID 83814-2390
- **Practice address phone:** (208) 664-8283
- **Mailing address:** 1420 LINCOLN WAY, SUITE 200, COEUR D ALENE, ID 83814-2390
- **Mailing address phone:** (208) 664-8283

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D4454 | ID | Yes |

## Other

- **Enumeration date:** 10/08/2012
- **Last updated:** 10/08/2012