Organization
AVELLE LICHFIELD ORTHO LLC
Active
Other names
Avelle Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
ETHAN LARSON DMD, MS (DOCTOR)
(253) 283-2747
Entity
Organization
Contact information
Practice address
14140 W INDIAN SCHOOL RD STE B1, GOODYEAR, AZ 85395-9293
(480) 712-9595
Mailing address
4365 E PECOS RD STE 136, GILBERT, AZ 85295-8053
(480) 712-9595
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
11/15/2024
Last updated
11/15/2024
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