Healthcare Provider Details

I. General information

NPI: 1760579403
Provider Name (Legal Business Name): STEVEN DENNIS LASSER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 NEW LONDON AVE
CRANSTON RI
02920-3035
US

IV. Provider business mailing address

245 LAUREL AVE
PROVIDENCE RI
02906-5730
US

V. Phone/Fax

Practice location:
  • Phone: 401-943-7535
  • Fax: 401-463-5693
Mailing address:
  • Phone: 401-274-3523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1726
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: