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Organization
LARSEN, DDS-BLANCHARD, DMD, PS
Active
Organization
LARSEN, DDS-BLANCHARD, DMD, PS
Active
Other names
Broadway Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL M LARSEN DDS (CO-OWNER)
(360) 249-3151
Entity
Organization
Contact information
Practice address
208 E BROADWAY AVE, MONTESANO, WA 98563-3706
(360) 249-3151
(360) 249-5129
Mailing address
208 E BROADWAY AVE, MONTESANO, WA 98563-3706
(360) 249-3151
(360) 249-5129
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DE00007407
WA
122300000X
Dentist
Primary
DE00008166
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5306808
—
WA
Enumeration date
09/15/2006
Last updated
08/22/2020
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