Individual
KELLY JAMES LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8086 E FLORENTINE RD, PRESCOTT VALLEY, AZ 86314-9422
(928) 772-8128
(928) 772-2369
Mailing address
8086 E FLORENTINE RD, PRESCOTT VALLEY, AZ 86314-9422
(928) 772-8128
(928) 772-2369
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D4296
AZ
Other
Enumeration date
11/08/2006
Last updated
07/08/2007
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