Provider Demographics
NPI:1154464022
Name:LASSITER, JAMES JOEL (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOEL
Last Name:LASSITER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 HWY 40 E. SUITE 1105
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-0862
Mailing Address - Country:US
Mailing Address - Phone:912-576-4011
Mailing Address - Fax:
Practice Address - Street 1:1891 HWY 40 E STE 1105
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6573
Practice Address - Country:US
Practice Address - Phone:912-576-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO128091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice