MEDICARE: ROBERT S.LASH, D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	DD1487	NM

General Provider Information

NPI Number	:	1982859112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT S.LASH, D.D.S.

Provider Business Mailing Address
First Line	:	10409 MONTGOMERY PKWY NE
Second Line	:	SUITE 100
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3852
Country	:	US
Telephone Number	:	505-291-8630
Fax Number	:	505-292-7563

Provider Business Practice Location Address
First Line	:	10409 MONTGOMERY PKWY NE
Second Line	:	SUITE 100
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3852
Country	:	US
Telephone Number	:	505-291-8630
Fax Number	:	505-292-7563

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT S. LASH
Credential	:	D.D.S.
Telephone Number	:	505-291-8630

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	12/22/2008

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