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LARSEN DENTAL CARE

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Company Details

Name: LARSEN DENTAL CARE
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 20 Jun 2005 (20 years ago)
Entity Number: 276493
Place of Formation: IDAHO
File Number: 0000276493
ZIP code: 83201
County: Bannock County
Mailing Address: 950 HOSPITAL WAY SUITE B POCATELLO, ID 83201

National Provider Identifier

NPI Number:
1104061449

Authorized Person:

Name:
DR. BRYCE R LARSEN
Role:
DENTIST OWNER
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
No
Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
2082332512

Filing

Filing Name Filing Number Filing date
Amendment of Certificate of Assumed Business Name 0000833691 2009-01-26
Initial Filing 0000276493 2005-06-20

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Date of last update: 24 Sep 2024

Sources: Idaho Secretary of State