Individual
DR. SCOTT COBURN LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
245 E BROADWAY, JACKSON, WY 83001
(307) 733-4778
(307) 734-8041
Mailing address
PO BOX 4935, 245 E BROADWAY, JACKSON, WY 83001
(307) 733-4778
(307) 734-8041
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1060
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118068100
—
WY
Enumeration date
09/06/2006
Last updated
07/08/2007
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