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General NPI Number Information
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NPI Number | 1245411099
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Entity Type | Individual
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Provider Name | ERIN LASSLO DDS
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Gender | Female
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 105 NORTH PARK LANE PO 70
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City | MISHICOT
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State | WI
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Zip | 54228
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Country | US
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Telephone | 920-755-2336
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 GRACE STREET
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City | DE PERE
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State | WI
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Zip | 54115
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Country | US
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Telephone | 414-526-6497
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6118-015
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License Number State | WI
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