Larsen Dental Care

NPI #1104061449 in Pocatello, Idaho

Provider Information

NPI Number: 1104061449
Entity Type: Organization
Organization Name: Larsen Dental Care
Primary Specialty: Dentist - General Practice
Enumeration Date: Dec 15, 2008
Last Updated: Dec 15, 2008

Practice Location

Address: 950 HOSPITAL WAY
Address 2: SUITE B
City: Pocatello
State: Idaho
ZIP Code: 83201-2789
Phone: (208) 233-7007

Authorized Official

Name: DR. BRYCE R LARSEN, D.M.D.
Title: DENTIST OWNER
Phone: (208) 233-7007

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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