Provider Demographics
NPI:1689934309
Name:CAREY V LASLEY DDS PLLC
Entity type:Organization
Organization Name:CAREY V LASLEY DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:V
Authorized Official - Last Name:LASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-866-9500
Mailing Address - Street 1:1801 W BAY DR NW
Mailing Address - Street 2:STE 101A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4310
Mailing Address - Country:US
Mailing Address - Phone:360-866-9500
Mailing Address - Fax:360-866-9490
Practice Address - Street 1:1801 W BAY DR NW
Practice Address - Street 2:STE 101A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4310
Practice Address - Country:US
Practice Address - Phone:360-866-9500
Practice Address - Fax:360-866-9490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6307122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty