Provider Demographics
NPI:1740376474
Name:LASLEY, CAREY VINCENT (DDS)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:VINCENT
Last Name:LASLEY
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 1:3250 14TH AVE NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8546
Mailing Address - Country:US
Mailing Address - Phone:360-866-9500
Mailing Address - Fax:360-866-9490
Practice Address - Street 1:3250 14TH AVE NW
Practice Address - Street 2:SUITE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8546
Practice Address - Country:US
Practice Address - Phone:360-866-9500
Practice Address - Fax:360-866-9490
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA63071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice