Provider Demographics
NPI:1245411099
Name:LASSLO, ERIN (DDS)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:LASSLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 GRACE STREET
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115
Mailing Address - Country:US
Mailing Address - Phone:414-526-6497
Mailing Address - Fax:
Practice Address - Street 1:105 NORTH PARK LANE
Practice Address - Street 2:PO 70
Practice Address - City:MISHICOT
Practice Address - State:WI
Practice Address - Zip Code:54228
Practice Address - Country:US
Practice Address - Phone:920-755-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6118-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist