Organization
PARK VIEW FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER SUE LARSON DDS (PRESIDENT / OWNER)
(231) 350-6747
Entity
Organization
Contact information
Practice address
202 N LAKE ST, BOYNE CITY, MI 49712-1210
(231) 582-4480
(231) 582-4460
Mailing address
202 N LAKE ST, BOYNE CITY, MI 49712-1210
(231) 582-4480
(231) 582-4460
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22901019425
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2901019425
STATE DENTAL LICENSE
MI
Enumeration date
11/25/2013
Last updated
11/25/2013
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