Provider Demographics
NPI:1801977228
Name:KALASKEY, LAWRENCE J III (DDS MS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:KALASKEY
Suffix:III
Gender:M
Credentials:DDS MS
Other - Prefix:DR
Other - First Name:LARRY
Other - Middle Name:J
Other - Last Name:KALASKEY
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:1217 VIRGINIA ST E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301
Mailing Address - Country:US
Mailing Address - Phone:304-345-4960
Mailing Address - Fax:304-345-4969
Practice Address - Street 1:1217 VIRGINIA ST E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301
Practice Address - Country:US
Practice Address - Phone:304-345-4960
Practice Address - Fax:304-345-4969
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3209122300000X
WV1011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134266000Medicaid