Provider Demographics
NPI:1063631117
Name:F. ANDREW LASLEY, IV, DMD, PLLC
Entity Type:Organization
Organization Name:F. ANDREW LASLEY, IV, DMD, PLLC
Other - Org Name:CENTRALIA ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:LASLEY
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-736-0129
Mailing Address - Street 1:PO BOX 675
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-0675
Mailing Address - Country:US
Mailing Address - Phone:360-736-0129
Mailing Address - Fax:360-330-2074
Practice Address - Street 1:2405 BORST AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-1411
Practice Address - Country:US
Practice Address - Phone:360-736-0129
Practice Address - Fax:360-330-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty