MEDICARE: DR. ANDREW J. LASK D.M.D.

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	1223G0001X	General Practice Dentistry	031991	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	031991	OTHER	NY	LICENSE NUMBER

General Provider Information

NPI Number	:	1912900564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW J. LASK D.M.D.

Provider Business Mailing Address
First Line	:	25 RAEMONT RD.
Second Line	:
City	:	GRANITE SPRINGS
State	:	NY
Zip	:	10527
Country	:	US
Telephone Number	:	914-248-7353
Fax Number	:

Provider Business Practice Location Address
First Line	:	66 MILTON RD.
Second Line	:	A13
City	:	RYE
State	:	NY
Zip	:	10580
Country	:	US
Telephone Number	:	914-967-1123
Fax Number	:	914-967-2776

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/07/2023

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