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General NPI Number Information
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NPI Number | 1265588412
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Entity Type | Organization
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Legal Business Name | MARK S. LASKA, D.D.S.
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Dates
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Enumeration Date | 01/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3460 WILSHIRE BLVD 210
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City | LOS ANGELES
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State | CA
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Zip | 90010-2206
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Country | US
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Telephone | 213-386-3348
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Fax | 213-386-3357
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Provider Business Mailing Address
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Address Line | 3460 WILSHIRE BLVD 210
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City | LOS ANGELES
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State | CA
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Zip | 90010-2206
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Country | US
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Telephone | 213-386-3348
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Fax | 213-386-3357
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Authorized Official
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Title or Position | OWNER
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Name | MARK SROL LASKA
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Credential | D.D.S.
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Telephone | 213-386-3348
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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 | 21155
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License Number State | CA
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