Organization
LARSEN FAMILY DENTISTRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT COBURN LARSEN DMD (DENTIST)
(307) 733-4778
Entity
Organization
Contact information
Practice address
3103 W BIG TRAIL DR, JACKSON, WY 83001-9296
(307) 733-4778
(307) 734-8041
Mailing address
PO BOX 4935, JACKSON, WY 83001-4935
(307) 733-4778
(307) 734-8041
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118068100
—
WY
Enumeration date
12/26/2007
Last updated
11/28/2017
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