Organization
LARSEN DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYCE R LARSEN D.M.D. (DENTIST OWNER)
(208) 233-7007
Entity
Organization
Contact information
Practice address
950 HOSPITAL WAY, SUITE B, POCATELLO, ID 83201-2789
(208) 233-7007
(208) 233-2512
Mailing address
950 HOSPITAL WAY, SUITE B, POCATELLO, ID 83201-2789
(208) 233-7007
(208) 233-2512
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D-1599
ID
1223G0001X
General Practice Dentistry
Primary
D-3894
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8072105
—
ID
Enumeration date
12/15/2008
Last updated
12/15/2008
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