Provider Demographics
NPI:1780840884
Name:SKENE, LARISSE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LARISSE
Middle Name:
Last Name:SKENE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5804 S COVE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6646
Mailing Address - Country:US
Mailing Address - Phone:801-652-7256
Mailing Address - Fax:
Practice Address - Street 1:166 E 5900 S STE B101
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7271
Practice Address - Country:US
Practice Address - Phone:801-270-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT700802899211223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics