Larissa Gushansky, DDS INC.
Dentist, General Practice in South Gate, CA. Organization (NPI-2).
NPI number1154516680
StatusActive
Last updated in NPPESNov 30, 2021
Details
- NPI
- 1154516680
- Entity type
- Organization (NPI-2)
- Legal business name
- Larissa Gushansky, DDS INC.
- Organization subpart
- No
- Enumeration date
- Sep 7, 2007
- Certification date
- Nov 30, 2021
- Last updated
- Nov 30, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Other names
- State Dental INC. (Other Name)
Practice location
3175 Firestone Blvd Ste 200South Gate, CA 90280-2951
Phone 323-563-9124 · Fax 323-563-9814
Mailing address
3175 Firestone Blvd Ste 200South Gate, CA 90280-2951
Phone 323-563-9124 · Fax 323-563-9814
Authorized official
Larissa Gushansky
Owner
3235639124
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