Healthcare Provider Details

I. General information

NPI: 1720539521
Provider Name (Legal Business Name): BARBARA LASKO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 WILSON ST STE 11
BREWER ME
04412-1558
US

IV. Provider business mailing address

PO BOX 322
BREWER ME
04412-0322
US

V. Phone/Fax

Practice location:
  • Phone: 207-745-2548
  • Fax:
Mailing address:
  • Phone: 207-745-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3058
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: