Active NPI
Erin Lasslo, DDS
- Dentist
- Mishicot, WI
National Provider Identifier
1245411099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6118-015
- Practice address
- 105 North Park Lane
PO 70
Mishicot, WI 54228 - Phone
- (920) 755-2336
- NPI assigned
- Nov 21, 2007
- Last updated
- Dec 13, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6118-015 | WI | Primary |
Addresses
Primary practice location
105 North Park Lane
PO 70
Mishicot, WI 54228
Mailing address
1820 Grace Street
De Pere, WI 54115
Phone (414) 526-6497
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150604000035 | WI | Order and Referring Only - Other (Non-Physician) | 6709945637 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6118-015 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1195603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197504000000",
"number": "1245411099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1820 GRACE STREET",
"city": "DE PERE",
"state": "WI",
"postal_code": "54115",
"telephone_number": "414-526-6497"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 NORTH PARK LANE",
"address_2": "PO 70",
"city": "MISHICOT",
"state": "WI",
"postal_code": "54228",
"telephone_number": "920-755-2336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LASSLO",
"first_name": "ERIN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-21",
"last_updated": "2007-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "6118-015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mishicot, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.