Provider Demographics
NPI:1265572507
Name:LASHLEY, CRAIG B (DDS)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:B
Last Name:LASHLEY
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 1:2105 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-1417
Mailing Address - Country:US
Mailing Address - Phone:316-773-1177
Mailing Address - Fax:316-773-2693
Practice Address - Street 1:2105 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-1417
Practice Address - Country:US
Practice Address - Phone:316-773-1177
Practice Address - Fax:316-773-2693
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice