Healthcare Provider Details

I. General information

NPI: 1477545135
Provider Name (Legal Business Name): WILLIAM L LASPE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 01/05/2020
Certification Date: 01/05/2020
Deactivation Date: 03/21/2006
Reactivation Date: 04/03/2006

III. Provider practice location address

15650 36TH AVE N
PLYMOUTH MN
55446-2560
US

IV. Provider business mailing address

3895 35TH ST SE
DELANO MN
55328-5200
US

V. Phone/Fax

Practice location:
  • Phone: 763-557-0287
  • Fax: 763-557-0295
Mailing address:
  • Phone: 541-784-5111
  • Fax: 763-557-0295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6134
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: