Provider Demographics
NPI:1699298471
Name:LASHENIK, STACY LYNN (LDH, OM)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:LASHENIK
Suffix:
Gender:F
Credentials:LDH, OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 FAIRLANE DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-3643
Mailing Address - Country:US
Mailing Address - Phone:219-730-6108
Mailing Address - Fax:
Practice Address - Street 1:7101 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8821
Practice Address - Country:US
Practice Address - Phone:219-730-6108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13004701A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist