Healthcare Provider Details

I. General information

NPI: 1730457219
Provider Name (Legal Business Name): DANIELLE MIGNON LASATER R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 EUCLID AVE
KANSAS CITY MO
64124-2323
US

IV. Provider business mailing address

504 SW MURRAY RD
LEES SUMMIT MO
64081-2345
US

V. Phone/Fax

Practice location:
  • Phone: 816-474-4920
  • Fax:
Mailing address:
  • Phone: 816-739-0729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2011017977
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number11364
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: