MEDICARE: DR. MICHAEL OLIVER LASKY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	43032	CA

General Provider Information

NPI Number	:	1841353372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL OLIVER LASKY DDS

Provider Business Mailing Address
First Line	:	12930 VENTURA BLVD STE 226C
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2200
Country	:	US
Telephone Number	:	818-465-7545
Fax Number	:	818-705-3086

Provider Business Practice Location Address
First Line	:	12930 VENTURA BLVD STE 226C
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2200
Country	:	US
Telephone Number	:	818-465-7545
Fax Number	:	818-705-3086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	11/03/2022

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