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6886 Indiana Ave Ste A Riverside CA 92506-4218 | |
| (951) 686-6410 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 6886 Indiana Ave Ste A, Riverside, California |
| Authorized Official Name and Position | Marc R Larson (OWNER/PROVIDER) |
| Authorized Official Contact | 9516866410 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6886 Indiana Ave Ste A Riverside CA 92506-4218 Ph: (951) 686-6410 | 6886 Indiana Ave Ste A Riverside CA 92506-4218 Ph: (951) 686-6410 |
| NPI Number | 1245965797 |
|---|---|
| Provider Enumeration Date | 07/19/2022 |
| Last Update Date | 09/19/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245965797 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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