Healthcare Provider Details

I. General information

NPI: 1841353372
Provider Name (Legal Business Name): MICHAEL OLIVER LASKY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12930 VENTURA BLVD STE 226C
STUDIO CITY CA
91604-2200
US

IV. Provider business mailing address

12930 VENTURA BLVD STE 226C
STUDIO CITY CA
91604-2200
US

V. Phone/Fax

Practice location:
  • Phone: 818-465-7545
  • Fax: 818-705-3086
Mailing address:
  • Phone: 818-465-7545
  • Fax: 818-705-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number43032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: