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General NPI Number Information
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NPI Number | 1508304650
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Entity Type | Organization
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Legal Business Name | MONROE DENTAL CLINIC GENERAL PARTNERSHIP
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 102 E WINDSOR STREET
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City | MONROE
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State | NC
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Zip | 28112
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Country | US
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Telephone | 704-292-1642
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Fax | 704-225-8291
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Provider Business Mailing Address
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Address Line | 102 E WINDSOR STREET
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City | MONROE
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State | NC
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Zip | 28112
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Country | US
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Telephone | 704-292-1642
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Fax | 704-225-8291
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK DAVID LASSITER
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Credential | DDS
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Telephone | 704-292-1642
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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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