Provider Demographics
NPI:1396388849
Name:LASKA DENTAL INC
Entity type:Organization
Organization Name:LASKA DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:SROL
Authorized Official - Last Name:LASKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-450-0300
Mailing Address - Street 1:5602 W MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045
Mailing Address - Country:US
Mailing Address - Phone:310-450-0300
Mailing Address - Fax:310-861-8122
Practice Address - Street 1:5602 W MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045
Practice Address - Country:US
Practice Address - Phone:310-450-0300
Practice Address - Fax:310-861-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2020-02-19
Deactivation Date:2020-01-03
Deactivation Code:
Reactivation Date:2020-02-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty