Healthcare Provider Details

I. General information

NPI: 1508926692
Provider Name (Legal Business Name): ROBERT STEVEN LASH D.D.S. , P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10409 MONTGOMERY PKWY NE SUITE 100
ALBUQUERQUE NM
87111-3852
US

IV. Provider business mailing address

10409 MONTGOMERY PKWY NE SUITE 100
ALBUQUERQUE NM
87111-3852
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-8630
  • Fax: 505-292-7563
Mailing address:
  • Phone: 505-291-8630
  • Fax: 505-292-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDD1487
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: