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General NPI Number Information
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NPI Number | 1427916246
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Entity Type | Organization
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Legal Business Name | KEVIN M. LASSITER, PLLC
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 11130 N TATUM BLVD STE 103
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City | PHOENIX
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State | AZ
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Zip | 85028-1675
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Country | US
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Telephone | 602-956-2260
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Fax |
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Provider Business Mailing Address
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Address Line | 3160 E FOX ST
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City | MESA
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State | AZ
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Zip | 85213-5418
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN LASSITER
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Credential | DMD
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Telephone | 762-444-1061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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