MEDICARE: RAYMOND LEE LASSITER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4366	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053320747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND LEE LASSITER DDS

Provider Business Mailing Address
First Line	:	302 E CENTERVIEW DRIVE
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023-2553
Country	:	US
Telephone Number	:	704-857-1711
Fax Number	:	704-857-4592

Provider Business Practice Location Address
First Line	:	302 E CENTERVIEW DRIVE
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023-2553
Country	:	US
Telephone Number	:	704-857-1711
Fax Number	:	704-857-4592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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