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General NPI Number Information
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NPI Number | 1265579866
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Entity Type | Individual
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Provider Name | MARK DAVID LASSITER SR. DDS
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 8487 S SCENIC HWY
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City | BLAND
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State | VA
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Zip | 24315-4691
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Country | US
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Telephone | 276-688-4711
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Fax | 276-688-4712
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Provider Business Mailing Address
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Address Line | 8487 S SCENIC HWY
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City | BLAND
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State | VA
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Zip | 24315-4691
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Country | US
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Telephone | 276-688-4711
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Fax | 276-688-4712
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6451
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License Number State | NC
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