Provider Demographics
NPI:1194921502
Name:CRAIG B LASHLEY DDS PA
Entity type:Organization
Organization Name:CRAIG B LASHLEY DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:B
Authorized Official - Last Name:LASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:316-773-1177
Mailing Address - Street 1:2105 N. RIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-1417
Mailing Address - Country:US
Mailing Address - Phone:316-773-1177
Mailing Address - Fax:316-773-2693
Practice Address - Street 1:2105 N. RIDGE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-1417
Practice Address - Country:US
Practice Address - Phone:316-773-1177
Practice Address - Fax:316-773-2693
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRAIG B LASHLEY DDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-22
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71271223G0001X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty