Provider Demographics
NPI:1811057805
Name:LASK, JOHN T (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:LASK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1504 NE 96TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1348
Mailing Address - Country:US
Mailing Address - Phone:816-415-4700
Mailing Address - Fax:816-415-4670
Practice Address - Street 1:1504 NE 96TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1348
Practice Address - Country:US
Practice Address - Phone:816-415-4700
Practice Address - Fax:816-415-4760
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO0160741223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO016074OtherDELTA DENTAL