Provider Demographics
NPI:1548629025
Name:LASLOVICH ORTHODONTICS
Entity type:Organization
Organization Name:LASLOVICH ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LASLOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-723-2144
Mailing Address - Street 1:2400 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6007
Mailing Address - Country:US
Mailing Address - Phone:406-723-2144
Mailing Address - Fax:406-723-2143
Practice Address - Street 1:2400 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6007
Practice Address - Country:US
Practice Address - Phone:406-723-2144
Practice Address - Fax:406-723-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-97181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty