Organization
BAYLAKES CENTER FOR COMPLEX DENTISTRY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH WILLIAM LASNOSKI DDS MS (PRESIDENT PROSTHODONTIST)
(920) 499-9958
Entity
Organization
Contact information
Practice address
138 SIEGLER ST, GREEN BAY, WI 54303
(920) 499-9958
(920) 499-1492
Mailing address
138 SIEGLER ST, GREEN BAY, WI 54303
(920) 499-9958
(920) 499-1492
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901015553
MI
1223P0700X
Prosthodontics
2901015553
MI
1223P0700X
Prosthodontics
Primary
5001473015
WI
Other
Enumeration date
09/28/2006
Last updated
04/22/2014
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