Stephen J Lasslo, D.D.S.
Individual provider Active NPI General Practice Dentistry · Wrightstown, WI
NPI 1205020732 · NPPES record last updated Apr 22, 2013
Key facts
- NPI
- 1205020732
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 6162-015 (WI)
- Practice address
- Wrightstown Dental 450 High St Ste 3
Wrightstown, WI 54180-1253 - Phone
- (920) 532-0091
- NPI assigned
- Aug 28, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150622002315 | WI | Order and Referring Only - Dentist |
4789995465 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6162-015 | WI | Yes |
Addresses
Primary practice location
Wrightstown Dental 450 High St Ste 3
Wrightstown, WI 54180-1253
Mailing address
Wrightstown Dental 450 High St Ste 3
Wrightstown, WI 54180-1253
Phone (920) 532-0091
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- Justin G Droessler
- Jacob Dyce
- Renee Fitzgerald
- Jennifer Ann Hansen
- Kami Jo Olson
- Matthew Olson
- Theresa Postell
- Primary Community Living LLC
- Alexis Riggs
All providers in Wrightstown, WI · General Practice Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.