MEDICARE: CIRCE LASSEGUE DDS, PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1801541438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIRCE LASSEGUE DDS, PLLC

Provider Business Mailing Address
First Line	:	21820 HEMPSTEAD AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-1235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21820 HEMPSTEAD AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-1235
Country	:	US
Telephone Number	:	305-793-9219
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CIRCE LASSEGUE
Credential	:	DDS
Telephone Number	:	305-793-9219

Provider Enumeration Date	:	02/11/2022
Last Update Date	:	02/11/2022

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