Provider Demographics
NPI:1205020732
Name:LASSLO, STEPHEN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:LASSLO
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:WRIGHTSTOWN DENTAL 450 HIGH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:54180-1253
Mailing Address - Country:US
Mailing Address - Phone:920-532-0091
Mailing Address - Fax:
Practice Address - Street 1:WRIGHTSTOWN DENTAL 450 HIGH ST STE 3
Practice Address - Street 2:
Practice Address - City:WRIGHTSTOWN
Practice Address - State:WI
Practice Address - Zip Code:54180-1253
Practice Address - Country:US
Practice Address - Phone:920-532-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6162-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice