Individual
DR. ETHAN JAMES LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D. M.S.
Contact information
Practice address
4365 E PECOS RD STE 136, GILBERT, AZ 85295-8053
(480) 712-9595
Mailing address
4365 E PECOS RD STE 136, GILBERT, AZ 85295-8053
(480) 712-9595
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D011332
AZ
Other
Enumeration date
05/30/2012
Last updated
11/15/2024
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