Provider Demographics
NPI:1962556498
Name:LASZLO, MARK ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:LASZLO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 SASHABAW RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-2067
Mailing Address - Country:US
Mailing Address - Phone:248-674-4171
Mailing Address - Fax:248-674-7372
Practice Address - Street 1:3714 SASHABAW RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-2067
Practice Address - Country:US
Practice Address - Phone:248-674-4171
Practice Address - Fax:248-674-7372
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist