Organization
FOREST VIEW DENTAL, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS J. LASELLE DDS (OWNER/ PRESIDENT)
(920) 733-1111
Entity
Organization
Contact information
Practice address
1111 W VALLEY RD, APPLETON, WI 54915-1485
(920) 733-1111
(920) 380-4056
Mailing address
1111 W VALLEY RD, APPLETON, WI 54915-1485
(920) 733-1111
(920) 380-4056
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3124-015
WI
1223G0001X
General Practice Dentistry
4766-015
WI
1223G0001X
General Practice Dentistry
5291-015
WI
Other
Enumeration date
06/28/2006
Last updated
08/22/2020
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