Individual
BRYCE ROBERT LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
950 HOSPITAL WAY, SUITE B, POCATELLO, ID 83201-2789
(208) 233-7007
(208) 233-2512
Mailing address
950 HOSPITAL WAY, SUITE B, POCATELLO, ID 83201-2789
(208) 233-7007
(208) 233-2512
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3894
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8072105
—
ID
Enumeration date
05/03/2007
Last updated
07/08/2007
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