Organization
CENTRAL COAST DENTAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNEST M LARSON (OWNER)
(435) 528-7266
Entity
Organization
Contact information
Practice address
85 N 100 E, STE B, GUNNISON, UT 84634-0400
(435) 528-7266
Mailing address
85 N 100 E, STE B, GUNNISON, UT 84634-0400
(435) 528-7266
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
08/18/2016
Last updated
09/07/2016
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