Healthcare Provider Details

I. General information

NPI: 1982859112
Provider Name (Legal Business Name): ROBERT S.LASH, D.D.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/22/2008
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: DR. ROBERT S. LASH
Title or Position: OWNER
Credential: D.D.S.
Phone: 505-291-8630