Organization
ADVANCED SOUTHLAKE ENDODONTICS, PLLC
Active
Other names
Southlake Endodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES MICHAEL LARSEN DDS (MEMBER)
(817) 488-3636
Entity
Organization
Contact information
Practice address
1100 E SOUTHLAKE BLVD, SUITE 400, SOUTHLAKE, TX 76092-6357
(817) 488-3636
(817) 421-2372
Mailing address
1100 E SOUTHLAKE BLVD, SUITE 400, SOUTHLAKE, TX 76092-6357
(817) 488-3636
(817) 421-2372
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/22/2008
Last updated
10/22/2008
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