Provider Demographics
NPI:1922185016
Name:LAKE MINNETONKA DENTAL
Entity Type:Organization
Organization Name:LAKE MINNETONKA DENTAL
Other - Org Name:BRYAN N LASKIN DDS PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:LASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-475-0225
Mailing Address - Street 1:109 BUSHAWAY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1945
Mailing Address - Country:US
Mailing Address - Phone:952-475-0225
Mailing Address - Fax:952-475-0776
Practice Address - Street 1:109 BUSHAWAY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1945
Practice Address - Country:US
Practice Address - Phone:952-475-0225
Practice Address - Fax:952-475-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty