Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 5078 | CT |
NPI | 1013144039 |
---|---|
Provider Name | Dr. Stella L. Laskowski |
First Address | Enfield, CT 06082 |
Second Address | Enfield, CT 06082 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2009 |
Last Update Date | 17/06/2009 |