Organization
LARSON FAMILY DENTISTRY
Active
Other names
Larson Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY J LARSON DDS (PARTNER)
(928) 772-8128
Entity
Organization
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
261QD0000X
Dental Clinic/Center
D008229
AZ
261QD0000X
Dental Clinic/Center
Primary
D04296
AZ
Other
Enumeration date
12/10/2015
Last updated
12/10/2015
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