MEDICARE: DENISSE LASANTA DMD

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	1223P0221X	Pediatric Dentistry	DN19520	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801174131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISSE LASANTA DMD

Provider Business Mailing Address
First Line	:	13110 ELK MOUNTAIN DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7182
Country	:	US
Telephone Number	:	813-349-7569
Fax Number	:

Provider Business Practice Location Address
First Line	:	7728 PALM RIVER RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-4215
Country	:	US
Telephone Number	:	813-630-3600
Fax Number	:	813-938-6428

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

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	12/23/2015

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Directions to “ DENISSE LASANTA DMD” Practice Location

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