Provider Demographics
NPI:1780059915
Name:LASLOVICH, JONNA MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:JONNA
Middle Name:MARIE
Last Name:LASLOVICH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JONNA
Other - Middle Name:MARIE
Other - Last Name:VANDAVEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6007
Mailing Address - Country:US
Mailing Address - Phone:406-723-2144
Mailing Address - Fax:406-723-2143
Practice Address - Street 1:2400 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6007
Practice Address - Country:US
Practice Address - Phone:406-723-2144
Practice Address - Fax:406-723-2143
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-97181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics