Individual provider Active NPI

Mark Andrew Laszlo, DDS

  • Dentist
  • Waterford, MI
National Provider Identifier
1962556498
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2901014428 Issued in MI
Practice address
3714 Sashabaw Rd
Waterford, MI 48329-2067
Phone
(248) 674-4171
Fax
(248) 674-7372
NPI assigned
Jan 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2901014428 MI Primary

Addresses

Primary practice location

3714 Sashabaw Rd
Waterford, MI 48329-2067

Mailing address

3714 Sashabaw Rd
Waterford, MI 48329-2067
Phone (248) 674-4171

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170106000638 MI Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 9436430428

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Laszlo, DDS, PC CurrentSince Jun 23, 2024 Accepting new patients

Locations

3714 Sashabaw Rd
Waterford, MI 48329
Phone (248) 674-4171

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718928000000",
    "number": "1962556498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3714 SASHABAW RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483292067",
            "telephone_number": "248-674-4171",
            "fax_number": "248-674-7372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3714 SASHABAW RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483292067",
            "telephone_number": "248-674-4171",
            "fax_number": "248-674-7372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASZLO",
        "first_name": "MARK",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2024-06-21",
        "certification_date": "2024-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901014428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

Verify at the official NPI Registry.