| Larissa Gushansky Dds, Inc. | |
|
3175 Firestone Blvd Suite200 South Gate CA 90280-2951 | |
| (323) 563-9124 | |
| (323) 563-9814 |
| Full Name | Larissa Gushansky Dds, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 3175 Firestone Blvd, South Gate, California |
| Authorized Official Name and Position | Larissa Gushansky (PRESIDENT) |
| Authorized Official Contact | 3235639124 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Larissa Gushansky Dds, Inc. 3175 Firestone Blvd Suite200 South Gate CA 90280-2951 Ph: (323) 563-9124 | Larissa Gushansky Dds, Inc. 3175 Firestone Blvd Suite200 South Gate CA 90280-2951 Ph: (323) 563-9124 |
| NPI Number | 1831383140 |
|---|---|
| Provider Enumeration Date | 08/29/2007 |
| Last Update Date | 08/29/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831383140 | NPI | - | NPPES |
| B36156-01 | Other | CA | DENTI-CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 36156 (California) | Primary |
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