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Organization
LARISSA GUSHANSKY DDS, INC.
Active
Organization
LARISSA GUSHANSKY DDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARISSA GUSHANSKY D.D.S. (PRESIDENT)
(323) 563-9124
Entity
Organization
Contact information
Practice address
3175 FIRESTONE BLVD, SUITE200, SOUTH GATE, CA 90280-2951
(323) 563-9124
(323) 563-9814
Mailing address
3175 FIRESTONE BLVD, SUITE200, SOUTH GATE, CA 90280-2951
(323) 563-9124
(323) 563-9814
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
36156
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B36156-01
DENTI-CAL
CA
Enumeration date
08/29/2007
Last updated
08/29/2007
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