Provider Demographics
NPI:1053320747
Name:LASSITER, RAYMOND LEE (DDS)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:LEE
Last Name:LASSITER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E CENTERVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHINA GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28023-2553
Mailing Address - Country:US
Mailing Address - Phone:704-857-1711
Mailing Address - Fax:704-857-4592
Practice Address - Street 1:302 E CENTERVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:CHINA GROVE
Practice Address - State:NC
Practice Address - Zip Code:28023-2553
Practice Address - Country:US
Practice Address - Phone:704-857-1711
Practice Address - Fax:704-857-4592
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995122Medicaid