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General NPI Number Information
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NPI Number | 1003000928
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Entity Type | Organization
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Legal Business Name | LARISSA GUSHANSKY, DDS INC.
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 887 E 2ND ST SUITE B
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City | POMONA
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State | CA
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Zip | 91766-2009
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Country | US
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Telephone | 909-865-8595
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Fax |
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Provider Business Mailing Address
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Address Line | 887 E 2ND ST SUITE B
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City | POMONA
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State | CA
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Zip | 91766-2009
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Country | US
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Telephone | 909-865-8595
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARISSA GUSHANSKY
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Credential |
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Telephone | 323-563-9124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 36156
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License Number State | CA
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