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General NPI Number Information
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NPI Number | 1346471687
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Entity Type | Organization
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Legal Business Name | BRAD A LARREAU DDS PS
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 3210 SMOKEY POINT DR STE 102
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City | ARLINGTON
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State | WA
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Zip | 98223-7805
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Country | US
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Telephone | 360-653-5577
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Fax | 360-659-1125
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Provider Business Mailing Address
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Address Line | 3210 SMOKEY POINT DR STE 102
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City | ARLINGTON
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State | WA
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Zip | 98223-7805
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Country | US
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Telephone | 360-653-5577
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Fax | 360-659-1125
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Authorized Official
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Title or Position | CONSULTANT
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Name | MS. JULIE A DODGE
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Credential |
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Telephone | 206-931-4410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 600074615
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License Number State | WA
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