Provider Demographics
NPI:1578158846
Name:LASKA DENTAL, LLC
Entity Type:Organization
Organization Name:LASKA DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LASKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-529-2280
Mailing Address - Street 1:5717 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-1941
Mailing Address - Country:US
Mailing Address - Phone:414-529-2280
Mailing Address - Fax:414-529-8770
Practice Address - Street 1:5717 S 108TH ST
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-1941
Practice Address - Country:US
Practice Address - Phone:414-529-2280
Practice Address - Fax:414-529-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental