Healthcare Provider Details

I. General information

NPI: 1164432985
Provider Name (Legal Business Name): ALAN LASCH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 EVERNIA ST DENTAL ADMINISTRATION
WEST PALM BEACH FL
33401-5709
US

IV. Provider business mailing address

901 EVERNIA ST DENTAL ADMINISTRATION
WEST PALM BEACH FL
33401-5709
US

V. Phone/Fax

Practice location:
  • Phone: 561-355-3082
  • Fax:
Mailing address:
  • Phone: 561-355-3082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN6874
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: