Provider Demographics
NPI:1902421035
Name:LASZLO, ANTHONY JACOB
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JACOB
Last Name:LASZLO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:JACOB
Other - Last Name:LASZLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600530122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist