NPI 1225759111
Lake Havasu Orthodontics LLC
Practice location
- Address
- 2061 Smoketree Ave N, Lake Havasu City, AZ 86403-5811
- Phone
- (928) 854-4141
- Mailing address
- 2212 E Aris Dr, Gilbert, AZ 85298-1205
Authorised official
- Name
- Ethan Larson
- Title
- Doctor/Owner
- Phone
- (253) 283-2747
Registered specialties
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
Registry record
- NPI
- 1225759111
- Entity type
- Organization
- NPI issued
- 8 Sep 2022
- Record last updated
- 8 Sep 2022
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.