Provider Demographics
NPI:1649333170
Name:LASKY, JILL COHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:COHEN
Last Name:LASKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19510 VENTURA BLVD
Mailing Address - Street 2:#207
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-708-2393
Mailing Address - Fax:818-705-3086
Practice Address - Street 1:19510 VENTURA BLVD
Practice Address - Street 2:#207
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-708-2393
Practice Address - Fax:818-705-3086
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA456691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry