Basic Information
| Provider Information | |||||||||
| NPI: | 1043621493 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LASSITER | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIT #28038 | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY BAVARIA | ||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 09112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 011499662834738 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | USA DENTAL HEALTH ACTIVITY | ||||||||
| Address2: | BLDG 38801 ACADEMIC DR, STE B&C | ||||||||
| City: | FT GORDON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309055660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067876927 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2014 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | D-4521 | ID | Y | Dental Providers | Dentist |
No ID Information.