MEDICARE: CHEYENNE R LASITER RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist

General Provider Information

NPI Number	:	1003625120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHEYENNE R LASITER RDH

Provider Business Mailing Address
First Line	:	510 W SAINT LOUIS AVE
Second Line	:
City	:	CARTHAGE
State	:	MO
Zip	:	64836-3063
Country	:	US
Telephone Number	:	918-219-4873
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 BROADWAY ST
Second Line	:
City	:	LAMAR
State	:	MO
Zip	:	64759-1224
Country	:	US
Telephone Number	:	417-262-6070
Fax Number	:	417-262-6071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2025
Last Update Date	:	01/03/2025

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