Individual
ERIC B LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4850 N 83RD AVE, PHOENIX, AZ 85033-1044
(623) 385-7100
Mailing address
6443 W ADOBE DR, GLENDALE, AZ 85308-7091
(406) 544-1961
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D012213
AZ
Other
Enumeration date
06/14/2024
Last updated
06/14/2024
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