Organization
AVELLE LICHFIELD ORTHO LLC
Active
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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