Provider Demographics
NPI:1043306095
Name:LARSEN AND POND FAMILY DENTISTRY
Entity Type:Organization
Organization Name:LARSEN AND POND FAMILY DENTISTRY
Other - Org Name:HILANDER DENTAL EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:POND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-636-5170
Mailing Address - Street 1:510 ALLEN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-4106
Mailing Address - Country:US
Mailing Address - Phone:360-636-5170
Mailing Address - Fax:360-636-0052
Practice Address - Street 1:510 ALLEN ST
Practice Address - Street 2:SUITE A
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-4106
Practice Address - Country:US
Practice Address - Phone:360-636-5170
Practice Address - Fax:360-636-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty