MEDICARE: LASHAWN JENAY HART

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	1223G0001X	General Practice Dentistry	11396	NC

General Provider Information

NPI Number	:	1427614031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHAWN JENAY HART

Provider Business Mailing Address
First Line	:	502 FONTAINE ST
Second Line	:
City	:	REIDSVILLE
State	:	NC
Zip	:	27320-3108
Country	:	US
Telephone Number	:	336-613-4918
Fax Number	:

Provider Business Practice Location Address
First Line	:	3219 WATKINS RD STE 103
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-3331
Country	:	US
Telephone Number	:	919-813-2267
Fax Number	:

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

Provider Enumeration Date	:	05/20/2019
Last Update Date	:	11/16/2023

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