Healthcare Provider Details

I. General information

NPI: 1386647386
Provider Name (Legal Business Name): ANDREW MARC LASKY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 18TH ST NW STE 201
WASHINGTON DC
20036-6501
US

IV. Provider business mailing address

1325 18TH ST NW STE 201
WASHINGTON DC
20036-6501
US

V. Phone/Fax

Practice location:
  • Phone: 202-463-6148
  • Fax: 202-887-5173
Mailing address:
  • Phone: 202-463-6148
  • Fax: 202-887-5173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN3418
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: