Healthcare Provider Details

I. General information

NPI: 1144782509
Provider Name (Legal Business Name): LASANTA & HERNANDEZ PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3622 SHANNON RD STE 101
DURHAM NC
27707-3771
US

IV. Provider business mailing address

3622 SHANNON RD STE 101
DURHAM NC
27707-3771
US

V. Phone/Fax

Practice location:
  • Phone: 919-493-1402
  • Fax: 919-403-2392
Mailing address:
  • Phone: 919-493-1402
  • Fax: 919-403-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. REINALDO LASANTA-GARCIA
Title or Position: MEMBER
Credential: DMD
Phone: 919-493-1402