Samuel Frederic Lasry, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS104576 Issued in CA

Practice address

1125 S Beverly Dr
Los Angeles, CA 90035-1148

Phone

(310) 734-7705

Fax

(661) 206-0223

NPI assigned

Aug 18, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advanced California Dental Clinic Inc

  • Dental Clinic/Center
  • Los Angeles, CA
  • NPI 1902472848
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597708800000",
    "number": "1639781966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1418 NEWTON ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900212726",
            "telephone_number": "310-734-7705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 S BEVERLY DR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900351148",
            "telephone_number": "310-734-7705",
            "fax_number": "661-206-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASRY",
        "first_name": "SAMUEL",
        "middle_name": "FREDERIC",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-18",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS104576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isabel Lasker
• Chederia Laskey
• Jenna Laski, MA
• Kevin Darneil Lasley
• Matteo Laspro
• Arden Ryland Lassalle, MT
• Julia Camille Lassegard, CRNA
• Kelsey Lassen
• Adam S Lasser, MD
• Charles Richard Lassman, MD

• General Practice Dentistry in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.