Basic Information
| Provider Information | |||||||||
| NPI: | 1598740425 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANTIN | ||||||||
| FirstName: | DANTE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 DOUGLAS ST | ||||||||
| Address2: | |||||||||
| City: | QUINCY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021696106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177700349 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 MOUNT VERNON ST | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021253120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172881140 | ||||||||
| FaxNumber: | 6172883910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 02/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 202772 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 141101 | 05 | MA | MEDICAID |