Provider Demographics
NPI:1184630139
Name:LASKEY, JOHN K (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:LASKEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 W WILLOUGHBY AVE
Mailing Address - Street 2:STE. 204
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1731
Mailing Address - Country:US
Mailing Address - Phone:907-586-9616
Mailing Address - Fax:907-586-1125
Practice Address - Street 1:641 W WILLOUGHBY AVE
Practice Address - Street 2:STE. 204
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1731
Practice Address - Country:US
Practice Address - Phone:907-586-9616
Practice Address - Fax:907-586-1125
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA04911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD0491Medicaid