Organization
LAKE HAVASU ORTHODONTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ETHAN LARSON DMD, MS (DOCTOR/OWNER)
(253) 283-2747
Entity
Organization
Contact information
Practice address
2061 SMOKETREE AVE N, LAKE HAVASU CITY, AZ 86403-5811
(928) 854-4141
Mailing address
2212 E ARIS DR, GILBERT, AZ 85298-1205
(253) 283-2747
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
09/08/2022
Last updated
09/08/2022
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