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1083975759
ETHAN JAMES LARSON
PUYALLUP, WA
NPI
1083975759
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics
(Licence: WA DE60199084)
Enumeration Date
2012-05-30
Last Update Date
2012-05-30
Business Address
Dr. ETHAN JAMES LARSON D.M.D. M.S.
210 4TH AVE SW
PUYALLUP, WA 98371-5863
Phone number: 253-848-4537
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Mailing Address
Dr. ETHAN JAMES LARSON D.M.D. M.S.
210 4TH AVE SW
PUYALLUP, WA 98371-5863
Phone number: 253-848-4537
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